Plan a fit trip



Business and family trips don’t have to derail your workout routine!

All it takes to stay active is a bit of research and forward thinking.

Get informed about the place you will be staying: do they have a gym, stairs, a pool, or a nearby walking trail?

Bring appropriate workout gear and draft a sensible exercise schedule.

Traveling in the near future?

Start looking into your fitness options this week.

If you plan ahead, you may be able to fit in fun excursions that count as both entertainment and activity.


About the Monday Campaigns:

The Healthy Monday Tips is produced by a national health promotion initiative called the Monday Campaigns.

The thinking behind the initiative derives from two studies done at the Center for a Liveable Future at Johns Hopkins Bloomberg School of Public Health by Jullian Fry and Roni Neff.

In one study, they reviewed the scientific studies that looked at ways to get people to adopt healthy habits.

In that review, they found that one of the most effective ways to keep people on track is simply to remind them from time to time to stick to it.

But when would be the best time send those reminders?

Fry and Neff decided to look at Monday, which many of us consider the start of our week.

To better understand how we thought and felt about Monday, they reviewed the scientific literature as well as cultural references to Monday in movies, songs, books and other forms of art and literature, even video games.

They noted that a number of scientific studies have found that we may suffer more health problems on Monday. For example, a number of studies find that Americans have more heart attacks and strokes on Monday.

There is also evidence that we have more on-the-job injuries on Monday, perhaps because we are not quite back into the swing of things, or are still recovering from our weekend.

Fry and Neff also found that while many of us, facing the return to work, may dread Mondays, Monday is also seen as a day for making a fresh start.

Fry and Neff concluded that Monday might be a good day for promoting healthy habits. Calling attention to the health problems linked to the first day of the work week, such as heart attacks and on-the-job injuries, makes Monday a natural day to highlight the importance of prevention.

And the Monday’s reputation as a day to make a fresh start offers the opportunity to help people to renew their efforts to adopt healthier habits.

Fry and Neff’s findings are put into practice by the Monday Campaigns, which helps individuals and organizations use Monday as a focus for their health promotion efforts, providing free research, literature and artwork, and other support.

To learn more about Healthy Mondays:

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100 days to the biggest ‘open-enrollment season we have ever seen’


film countown 397By Phil Galewitz and Jay Hancock
KHN Staff Writers

At the Silver State Health Insurance Exchange in Carson City, Nev., workers have been counting down the days until Oct. 1 on an office corkboard.

Today is a big milestone — 100 days to the deadline for opening the online marketplaces that are a linchpin of the federal health law known as Obamacare.

“We certainly will need every one of the days that we have left,” said Jon Hager, executive director of the Nevada exchange. “But I am confident we will be ready to go.”

Nevada is one of 15 states racing to launch their own marketplaces where consumers can compare plans’ prices and benefits, and find out if they are eligible for a federal subsidy or Medicaid. The other states are relying on the federal government.

Those marketplaces, also called exchanges, are key to expanding insurance coverage to an estimated 25 million Americans over the next decade.

‘The next hundred days are the sprint to the biggest open-enrollment season we’ve ever seen in this country,” said Ceci Connolly, managing director of PricewaterhouseCoopers’ Health Research Institute. “We know that this will be a real crunch period.”

‘The next hundred days are the sprint to the biggest open-enrollment season we’ve ever seen in this country.”

Opening the marketplaces on time represents the Obama administration’s biggest opportunity to fulfill the law’s promise to extend coverage to uninsured Americans, including those who have been denied coverage in the past because of health conditions.

Since the Supreme Court upheld the law last June, though, officials have had to overcome many hurdles, from states’ reluctance to participate, to critics’ predictions of unaffordable coverage, to unexpectedly tight money.

A quirk in the law gave generous funding for consumer outreach in states with their own marketplaces, but little for states with a federal exchange. That could be a problem since polls show that most Americans know little about how the law affects them.

There are also technical challenges: Obamacare supporters like to compare shopping on the exchanges to buying an airplane ticket on Travelocity or Expedia, but building the back-end system is far more complicated, requiring computers at state and federal agencies to be able to talk to one another in real time to verify an individual’s income and citizenship status, and determine eligibility for federal subsidies or Medicaid, the state-federal insurance program for the poor.

That system also needs to connect with the computers run by insurance companies.

The biggest questions, though, revolve around who will show up and whether they will be able to afford coverage that takes effect Jan. 1 — especially the young and healthy, who will need to buy insurance in significant numbers to balance the costs of insuring the sick, who can no longer be turned away.

The law requires most Americans to carry insurance in 2014, but some fear that the first-year, $95 penalties won’t be a strong enough inducement.

If mostly older, sicker people show up, insurers will pass on their health care costs in higher premiums that will make coverage for all individuals less affordable over time.

Political Backdrop

ACA health reform logoAll of these challenges are occurring in a politically charged environment in which both parties are already spinning developments to buttress their positions on the law.

While the law’s effectiveness won’t truly be known for several years, underwhelming enrollment and high premiums could turn public opinion against Democrats before next year’s elections.

When government auditors released a report last week, for instance, saying the Obama administration faced challenges to open the federally run exchanges in time, Republicans pounced.

“The (Government Accountability Office) report underscores the sad reality that the administration is still woefully unprepared for implementation despite the law being signed over three years ago,” said Rep. Fred Upton, the Michigan Republican who chairs the House Energy and Commerce Committee.

President Barack Obama insists the exchanges will open on time and coverage will be affordable, although he acknowledges there will be bumps along the way, as there would be for any new program. In July, the administration plans to re-launch, the web portal for the federally run exchanges.

Short on money and worried about starting outreach during the summer vacation period, the administration won’t launch its major public campaign until at least mid-September.

But supporters of the law, such as the nonprofit Enroll America, are planning to use the 100-day milestone to start their own efforts.

Flag_of_ColoradoSeveral states running their own exchanges, including Connecticut, Colorado and Kentucky, have recently begun airing television commercials about the new options that will be available Oct. 1, for coverage that begins in January. Open enrollment runs through March.

“People need to know this is coming so they can start thinking about it,” said Carrie Banahan, executive director of the Kentucky exchange that recently rebranded itself as Kynect — Kentucky’s Healthcare Connection.

“Insurance is complicated and we wanted to try to make it easily understandable as possible,” she said.

Kentucky’s exchange, which expects up to 200,000 people to enroll in the first year, has been testing whether its computer systems can connect with federal agencies, as well as its Medicaid program.

“We are meeting all our deadlines and are on track,”” Banahan said.

This summer, it plans to begin marketing at minor league baseball games and the state fair. In September, it plans to have a booth at one of the state’s biggest early fall events — the Bourbon Festival.

The state-run exchanges are at various levels of readiness. California’s, for example, has approved insurance plans it will offer and awarded money to groups that will train guides to assist consumers.

Idaho, whose legislature did not approve the exchange until March, has not even selected a name or chosen a vendor to build its website, said Stephen Weeg, chairman of the exchange.

“We are going to have to be like Star Wars and do everything at hyper-speed,” he said.

Nevada’s To Do List

Nevada linkNevada’s Hager said that state will not start its publicity push until Oct.  7 so the exchange has time to work out any problems before too many consumers rush in.

In the next three months, it must certify health plans, test computer systems and begin an outreach effort that will include television and radio ads and knocking on doors.

The exchange, which will use in its marketing, hopes to enroll 118,000 people in first year, Hager said.

Though most of the focus is on states and the federal government, hundreds of private companies are doing much of the work, including information technology firms such as Xerox, and religious organizations and chambers of commerce,that will educate individuals and small employers about their new insurance options.

Insurers, who have the most to gain from robust enrollment, including Florida’s largest insurer, plan to launch education campaigns to counter widespread ignorance about the health law.

“This is a huge communication and education undertaking for us,” said Jon Urbanek, senior vice president of commercial markets for Florida Blue, the Blue Cross and Blue Shield in that state. Among people eligible for subsidized coverage, he added, “a lot of those don’t even know what health insurance is.””

This article was reprinted from 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.


Health headlines from this week’s Seattle Times

Sunday, June 23, 2013
Seattle Times News Partner

Picture this, children, books full of food that’s good for you
Fruits and vegetables are finding a place in children’s books, which have often made a piece of cake the childhood equivalent of heaven. (Sun, 6/23)

One healthful thing we love
Snoqualmie Tunnel Bike Ride, June 29 (Sun, 6/23)

The People’s Pharmacy
People’s Pharmacy: Noxzema helps a young eczema sufferer
People’s Pharmacy on Noxzema for eczema, cough caused by ACE inhibitors, and Coenzyme Q10 for those on statin-type drugs.(Sun, 6/23)

What does the debate about salt mean for me?
The Institute of Medicine has increased its maximum recommended sodium intake for adults over 50 and those with heart risk from 1,500 milligrams (mg) to 2,300. But the American Heart Association is sticking with 1,500 mg. Confused? Here’s some help. (Sun, 6/23)

Scientists create detailed 3-D model of human brain
BigBrain reveals the brain’s structures with a resolution that’s 50 times better than the brain maps produced by MRI scanners. (Sat, 6/22)

Debate erupts over labeling obesity as disease
Though fat activists demand that the AMA reverse its position, calling obesity a disease will open doors to better treatment and better reimbursements, said Dr. Steve Smith, president-elect of The Obesity Society. (Sat, 6/22)

Bacteria gobble stench from tony seaside cove
San Diego officials think they at last have a solution to the guano-caused stench that has increasingly tainted the La Jolla Cove experience: guano-eating bacteria. (Sat, 6/22)

Fit For Life
Take a good, long ride and reap the rewarding eats
Riding to eat sounds like Fit for Life columnist Nicole Tsong’s perfect day. Cycle hard, enjoy the view, eat. (Fri, 6/21)

Fit & Fun
Challenge yourself with paddleboarding
There are several locations to check out paddleboarding, including the Monday night races hosted by Salmon Bay Paddle in Ballard. (Thu, 6/20

High court: U.S. funds can’t be used to limit groups’ speech
The case raised the recurring question of whether the government can use its funding power to require grant recipients to follow its rules and policies. (Thu, 6/20)

New King County policy requires drugmakers to create disposal plans 
A new Board of Health rule makes drug manufacturers pay for a safe medicine-disposal program in King County. (Thu, 6/20)

HPV vaccine cut infection by half in teen girls 
A vaccine against a cervical cancer virus cut infections in teen girls by half in the first study to measure the shot’s impact since it came on the market. The results impressed health experts and a top government top health official called them striking. (Wed, 6/19)

New MERS virus spreads easily, deadlier than SARS
The experts reported that MERS infection occurred by way of person-to-person contact and poses an especially serious risk because it is easily transmitted in hospital settings. (Wed, 6/19)

Swedish to introduce new plans for growth
After plans to increase of its Cherry Hill campus raised concerns among residents in the surrounding Squire Park neighborhood of Seattle, Swedish Medical Center will propose different expansion ideas. (Wed, 6/19)

‘I don’t want to be only person cured of HIV’
Timothy Ray Brown, a native of Seattle who was the first person cured of the AIDS virus, is joining with scientists at the Fred Hutchinson Cancer Research Center to help extend the cure to others. (Tue, 6/18)


Blue Cross-Blue Shield bets big on Obamacare


bluecrossblueshieldl_2By Jay Hancock
KHN Staff Writer

At a closed White House meeting in April, President Barack Obama told corporate insurance bosses “we’re all in this together” on implementing his signature health law. But some insurance companies seem to be more in than others.

At least five Blue Cross and Blue Shield executives sat at the table of about a dozen CEOs with the president, according to those knowledgeable about the session, first reported by the New York Times.

Just as significant is who wasn’t there: chiefs of the country’s biggest and third-biggest health insurers, UnitedHealth Group and Aetna.

Those two and most other non-Blue insurers “seem to be proceeding cautiously” in the online marketplaces expected to cover to millions, said David Windley, who follows the industry for Jefferies & Co., an investment firm. “They are evaluating markets state by state and in some cases region by region within the state to assess the viability of all the different pieces.”

Not the Blues. They’re expected to offer health-exchange plans nearly everywhere, ensuring at least a minimum choice for individuals seeking subsidized coverage when the marketplaces open Oct. 1.

It also makes them an undeclared Obama ally in implementing the health law.

“The Blues will definitely participate,” said Ana Gupte, an insurance stock analyst for Dowling & Partners. “If there is an exchange I’m sure there will be the Blues.”

The exchanges are online marketplaces that will operate in all 50 states, offering insurance plans for individuals and small businesses. The individual market has long been a high-risk, unstable business that some insurers never sought.

The health law – with its mandate that could bring younger, healthier people into the pool and its subsidies – seeks to stabilize the individual market.

But if few other insurers follow the Blues into those markets, consumers in those states may not see the same kind of competitive pricing of premiums that states like Oregon have reported.

Still, it’s not just that Blues will offer coverage in places other carriers may avoid. In states where Republican governors oppose the health law, Blues may be the single biggest factor in educating consumers and recruiting them into Obamacare.

In Louisiana, where Gov. Bobby Jindal has flatly said “we are not implementing the exchange,” the local Blues plan has organized community nonprofits, churches, chambers of commerce and food banks to get out the word on what will be a federally run marketplace there.

BlueCross BlueShield of Louisiana “is the driving force” behind the Louisiana Healthcare Education Coalition, launched in March, said Nebeyou Abebe, who works on consumer engagement at the Louisiana Public Health Institute. “I can’t think of any other entity in Louisiana that’s developing a massive campaign to educate people.”

Founded by hospitals and doctors before World War II, the Blues are a loose federation of nonprofit and for-profit plans with a history of selling coverage directly to individuals and families.

The Concerns Of Insurers

The Affordable Care Act requires exchange plans to cover anybody, no matter how sick, at regulated prices and often with large government subsidies.

Despite the prospect of millions of new customers and measures to cushion insurers with disproportionately high claims in the early years, carriers worry that the sick will be first to sign up while the healthy stay away.

Fears grew after claims came in far higher than expected for temporary “high risk pools” that had been established by the law to cover the chronically ill until the full law took effect in 2014. The shortfall prompted the plans to close enrollment early.

“Insurance companies, very suddenly in my estimation, are getting very conservative and hesitant about being in the exchanges,” said Robert Laszewski, a Virginia-based consultant and former insurance executive. “All along everybody, including the companies, assumed they would be in a lot of exchanges.”

Carriers also fear Democrats will blame them if government-run online marketplaces suffer technical failures or run into other problems, Laszewski said.

UnitedHealth Group’s recent disclosure that it would offer plans in only a dozen state exchanges marked new disappointment for those hoping the exchanges will generate vigorous competition and new insurance for millions. Previously United had said it would sell on as many as 25 exchanges.

The company will “watch and see” how exchanges work, “approaching them with some degree of caution,” UnitedHealth Group CEO Stephen Hemsley told analysts last month.

Aetna plans to offer individual exchange policies in 14 states and may reduce that if some states look unprofitable or unprepared, CEO Mark Bertolini said on a conference call in late April. On June 17 Aetna disclosed it would stop selling individual insurance in California, the most populous state.

For its part, Cigna will focus on making exchange plans work well in five states rather than spreading efforts more thinly, said Ray Smithberger, who’s in charge of the company’s individual business.

“What you see in the general market is just a hesitancy” over whether states will be technologically ready, he said in an interview. “With condensed time frames, it’s important that we provide the right connectivity to ensure we’re providing the best experience for the customer.”

Although not every state has announced online marketplace participants, the Blues characterize their approach very differently. “We expect Blue Cross Blue Shield plans will have a strong, reliable presence in the new exchanges,” said Alissa Fox, a senior vice president at the Blue Cross and Blue Shield Association. “We’ve been in this market for more than 80 years and we’ve been providing coverage in every zip code to everybody. We imagine we will continue to do that.”

Five Blues executives attended the meeting with Obama on April 12 to coordinate exchange implementation: Scott Serota, CEO of the Blue Cross and Blue Shield Association; Florida Blue CEO Patrick Geraghty; Chet Burrell, CEO of CareFirst BlueCross BlueShield, with plans in Maryland and D.C.; Patricia Hemingway Hall, CEO of Health Care Service Corp., with Blues plans in four states; and WellPoint CEO Joseph Swedish. WellPoint is the No. 2 health insurer and operates Blues plans in 14 states.

The White House declined to release the full list of attendees. Nor does it comment “on the role of one company or provider” in implementing the health act, a spokeswoman said.

Protecting Their Business

Blues aren’t the only alternative to national commercial insurers. In many states there are regional nonprofits such as Group Health Cooperative in the Northwest or Presbyterian Health Plan in New Mexico. But for health coverage sold directly to consumers — the kind that will be offered on the exchanges — Blues have the most members in a large majority of states.

Protecting that business is why Blues have little choice but to offer plans in the online marketplaces, analysts said. If they abstain, they risk losing those members. Once in the game, they need to recruit as many customers as possible to avoid signing a disproportionate share of the sick.

Florida Blue, which owns about half the market in that state for individual insurance, intends to use its 11 recently opened retail centers to get out the word and will rent temporary storefronts in key neighborhoods, said Jon Urbanek, senior vice president of commercial markets for the company. Florida Blue will double the size of its call center to 200 employees as October approaches, he said.

“In campaign terms, it’s a get-out-the-vote type of approach,” said Michelle Riddell, vice president of community investment for BlueCross BlueShield of Texas.

Like the Louisiana Blues, the Texas Blues are educating and recruiting exchange customers with little cooperation from the state. Texas and Louisiana are among 33 states leaving exchange implementation to the federal government amid questionsabout whether it has the resources to educate a broadly ignorant public.

The Texas insurer’s Be Covered Texas team includes Habitat for Humanity, diabetes groups, churches, social services nonprofits, the NAACP and community clinics — all putting out the Obamacare word in the state with the highest percentage of uninsured people in the country.

The campaign includes a Web site, a texting campaign and community events planned through the rest of the year. A Blues official recently spoke to the Houston congregation of Windsor Village United Methodist Church, which has more than 16,000 members. Food bank grocery bags bear printed information about health insurance. Barber shops are seen as health information hubs.

Be Covered Texas doesn’t mention Blue Cross, presenting itself as a grass-roots program. Health Care Services Corp., the parent of the Texas Blues, hasn’t disclosed how much it is spending on the Texas effort and similar outreach by its Blues plans in New Mexico, Illinois and Oklahoma, a spokesman said.

“I view this as a three-year project,” said Bert Marshall, president of BlueCross BlueShield of Texas. “I think the education piece is going to last well beyond this enrollment and well beyond the next.”

With his company holding more than half of the Texas individual insurance market, Marshall believes an early and extended campaign is a good investment. His competitors seem to have a different view.

“The Blue Cross plans… are going to be in the exchanges because it’s part of their DNA,” said Laszewski. “But the rest of the marketplace, if you go look at their block of individual business, it’s small, and it’s probably losing money

This article was reprinted from 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.


Report: 121 participated in state’s Death with Dignity program in 2012


Seal_of_WashingtonOf the 121 who requested and receive prescriptions for lethal doses of medication under Washington’s Death with Dignity Act, at least 83 died after taking the drugs, according to the state’s fourth annual Death with Dignity Act report released Thursday,

Overall, 104 people who were dispensed lethal doses of medication in 2012 are known to have died, the report said.

Since the 2009 law was passed, 376 terminally ill adults have received medication in the state. The new report covers January 1 to December 31, 2012.

As in previous years, many of the patients who received medication told prescribing physicians about concern over loss of autonomy as a reason for participating, the report said.

According to the report by the Washington State Department of Health:

  • Number of patients participating increased 17 percent in 2012 from 2011.
  • Death with Dignity participants who died in 2012 were between the ages of 35 and 95.
  • More than 90 percent lived west of the Cascades.
  • Most had cancer.

To learn more:


King County to launch its own drug take-back program.

A jumble of pill bottles

Photo by Erin DeMay via Flickr

King County Board of Health voted Thursday to create a drug take-back system for King County.

The program will promote the safe disposal of unused prescription and over-the-counter medicines, and will be funded and operated by the drug manufacturers who produce the medications.

“About 30% of prescription and over-the-counter medicines go unused, and too often linger in home medicine cabinets increasing risks of misuse or abuse,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “A safe and convenient drug disposal system for prescription and over-the-counter drugs will serve the public’s health.”

Alameda County in California passed similar legislation last year, though PhRMA (Pharmaceutical Research and Manufacturers of America) has sued to block the law from taking effect, King County Board of Health officials said.

Under the new program residents may dispose of unwanted medicines at pharmacies and other secure locations across the county for no charge.

“Today’s vote makes us the second jurisdiction in the nation to provide a safe and convenient way for residents to get rid of their unneeded medicines,” said Board of Health Chair Joe McDermott.

Nationwide more people die from overdoses due to prescription medicines than from heroin and cocaine combined and that most abusers of medicines get the pills from a friend or relative’s medicine cabinet. In Washington 32% of child poisoning deaths  were caused by someone else’s prescription medication, and 26% were caused by over-the-counter medicines.

Under the new program:

  • Residents will be encouraged to drop, free-of-charge, their leftover and expired medicines in secure boxes conveniently located in most retail pharmacies or law enforcement offices throughout King County;
  •  Collected medicines would then be destroyed by incineration at properly permitted facilities;
  • Drug manufacturers selling medicines for residential use in King County would be required to run and pay for the program; and
  • Public Health – Seattle & King County would oversee the program to ensure its effectiveness and safety.

FDA approves “morning after pill” for over-the-counter sale


planb-175The US Food and Drug Administration (FDA) has approved the so-called “morning after pill” Plan B One-Step for over-the-counter sale.

That means the emergency contraceptive can be purchased by all women of “child-bearing potential” without a prescription, the FDA said..

Plan B One-Step can prevent  pregnancy following unprotected sexual intercourse or a known or suspected contraceptive failure, such as may occur with a condom, if taken as soon as possible within three days after unprotected sex.

Plan B One-Step was first approved in July 2009 for use without a prescription for women age 17 and older and as a prescription-only option for women younger than age 17.

The  drug contains higher levels of a hormone found in some types of daily use oral hormonal contraceptive pills and works in a similar way to these contraceptive pills by stopping ovulation and therefore preventing pregnancy.

Plan B One-Step will not stop a pregnancy when a woman is already pregnant and there is no medical evidence that the product will harm a developing fetus, the FDA said.

The product, however, will not protect a woman from HIV/AIDS or other sexually transmitted diseases, and so it is important that young women who are sexually active see a healthcare provider for routine checkups, the FDA warned.

The health care provider should counsel the patient about, and test them for sexually transmitted diseases, discuss effective methods of routine birth control, and answer any other questions the patient may have, the FDA said.

Some women taking Plan B One-Step have reported experiencing the following side effects:  nausea, vomiting, stomach pain, headache, dizziness and breast tenderness. These are similar to the side effects of regular prescription-only birth control pills.


Medicare failing to track “extreme” prescribers – report


Inspector General Faults Medicare for Not Tracking ‘Extreme’ Prescribers

By Tracy WeberCharles Ornstein and Jennifer LaFleur

womans-hand-picking-up-pillsMore than 700 doctors nationwide wrote prescriptions for elderly and disabled patients in highly questionable and potentially harmful ways, according to a critical report of Medicare’s drug program released today.

The review by the inspector general of the U.S. Department of Health and Human Services flags those doctors as “very extreme” in their prescribing – and says that Medicare should do more to investigate or stop them.

The study mirrors a ProPublica investigation last month that found Medicare had failed to protect patients from doctors and other health professionals who prescribed large quantities of potentially harmful, disorienting or addictive drugs.

Medicare’s prescription drug program was launched in 2006 and now accounts for about one of every four drugs dispensed nationwide. Last year, the government spent $62 billion subsidizing the drugs of 32 million people.

“Strong oversight of the Medicare prescription drug program is critical for protecting patients from harm,” Sen. Tom Carper, D-Del., said in an email.

Carper chairs the Senate Homeland Security and Governmental Affairs Committee, which has scheduled a hearing Monday about prescription abuse in the Medicare program, known as Part D.

The inspector general’s report focused on the prescribing of nearly 87,000 general-care physicians, such as family practitioners and internists, in urban and suburban areas in 2009. These doctors accounted for about half of all the prescribing in the program that year.

The review found more than 2,200 doctors whose records stood out in one of several areas: prescriptions per patient, brand name drugs, painkillers and other addictive drugs or the number of pharmacies that dispensed their orders.

Of those, 736 were flagged as “extreme outliers.” Their patterns, the report says, raised questions about whether the prescriptions were “legitimate or necessary.”

For instance, 24 doctors wrote more than 400 prescriptions for at least one patient, including refills dispensed. One Ohio physician did so more than a dozen times, according to the report. The average doctor wrote 13 per patient.

In another case, an Illinois doctor had prescriptions filled by 872 pharmacies in 47 states and Guam. General-care doctors, on average, had prescriptions for all their Medicare patients filled by 52 pharmacies.

The cost to the government was enormous in some instances. Medicare paid $9.7 million for the prescriptions of one California doctor alone – that is 151 times more than the cost of an average doctor’s tally, the report says.

Most of this physician’s drugs were supplied by just two pharmacies, both of which had previously been identified by the inspector general as having questionable billing practices.

All told, the drugs ordered by the doctors labeled “extreme outliers” cost Medicare $352 million, the report says.

While some of this may have been appropriate, the report says, “prescribing high amounts on any of these measures may indicate that a physician is prescribing drugs which are not medically necessary or that he or she has an inappropriate incentive, such as a kickback, to order certain drugs.”

Sen. Tom Coburn of Oklahoma, the ranking Republican on Carper’s committee, said no one wants Medicare to tell doctors which drugs to prescribe. But the government does have a responsibility in preventing fraud and abuse, he said.

Medicare officials “should be using their data to make sure those practicing medicine are practicing medicine and not practicing a sham,” said Coburn, who is also an obstetrician.

The inspector general’s report calls on the Centers for Medicare and Medicaid Services (CMS), which oversees the program, to step up scrutiny of doctors with questionable prescribing patterns. It urged CMS to direct its fraud contractor to expand its analysis of prescribers and train the private insurers that administer Part D on how to spot problem prescribers.

Medicare also should send doctors report cards comparing their prescribing to their peers, the report says.

In a response to the inspector general, the Medicare agency wrote that it agreed with the recommendations, has been working to reduce overuse of narcotics and plans to expand its use of data to flag questionable prescribing.

“We must balance these efforts with ensuring that beneficiaries have access to the medicines they need,” a CMS spokesman said Wednesday in a statement.

For ProPublica’s investigation, reporters analyzed four years of Medicare prescription drug data and examined the prescriptions of all health professionals across specialties. It examined all prescribers – 1.7 million in 2010 alone – not just those in general-care specialties or mostly urban areas.

The new report from the inspector general is the latest to find oversight problems in Part D. Previous reports found that insurers have paid for prescriptions from doctorswho were barred by Medicare or whose identities were unknown to insurers or Medicare.

Coburn said Medicare has had repeated warnings that it was failing to properly oversee the program.

“This is incompetency and lack of somebody being held accountable,” he said. “It’s fixable.”

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


Have diabetes? Travel tips from the CDC


Safe travel tips from the US Centers for Disease Control and Prevention

Glucometer showing a blood sugar of 105Getting out of the routine is part of the fun of vacation and traveling. But your care routine should travel with you, especially if you have diabetes.

Meals away from home, changes in how much physical activity you get, and differences in time zones as you travel can affect how well you manage diabetes. Use this time to be refreshed, lose the stress, and be open to healthy habits. Before you hit the road, review these tips for taking care of yourself.

Don’t Forget Your Medication

  • Pack twice the amount of diabetes supplies you expect to need, in case of travel delays.
  • Keep snacks, glucose gel, or tablets with you in case your blood glucose drops.
  • Make sure you keep your health insurance card and emergency phone numbers handy, including your doctor’s name and phone number.
  • Carry medical identification that says you have diabetes.
  • Keep time zone changes in mind so you’ll know when to take medication.
  • If you use insulin, make sure you also pack a glucagon emergency kit.
  • Have all syringes and insulin delivery systems (including vials of insulin) clearly marked with the pharmaceutical preprinted label that identifies the medications. Keep it in the original pharmacy labeled packaging.
  • Find out where to get medical care if needed when away from home.
  • Take copies of prescriptions with you.

On the Road

  • Reduce your risk for blood clots by moving around every hour or two.
  • Pack a small cooler of foods that may be difficult to find while traveling, such as fresh fruit, sliced raw vegetables, and fat-free or low-fat yogurt.
  • Bring a few bottles of water instead of sugar-sweetened soda or juice.
  • Pack dried fruit, nuts, and seeds as snacks. Since these foods can be high in calories, measure out small portions (¼ cup) in advance.

In the Air

  • If you’re flying and do not want to walk through the metal detector with your insulin pump, tell a security officer that you are wearing an insulin pump and ask them to visually inspect the pump and do a full-body pat-down.
  • Place all diabetes supplies in carry-on luggage. Keep medications and snacks at your seat for easy access. Don’t store them in overhead bins or checked luggage.
  • If a meal will be served during your flight, call ahead for a diabetic, low fat, or low cholesterol meal. Wait until your food is about to be served before you take your insulin.
  • If the airline doesn’t offer a meal, bring a nutritious meal yourself.
  • Make sure to pack snacks in case of flight delays.
  • When drawing up your dose of insulin, don’t inject air into the bottle (the air on your plane will probably be pressurized).
  • Reduce your risk for blood clots by moving around every hour or two.

Staying Healthy

  • Changes in what you eat, activity levels and time zones can affect your blood glucose. Check levels often. Talk with your doctor before increasing physical activity, such as going on a trip that will involve more walking.
  • Stick with your exercise routine. Make sure to get at least 150 minutes of physical activity each week.
  • Wash hands often with soap and water.
  • Protect your feet. Be especially careful of hot pavement by pools and hot sand on beaches. Never go barefoot.
  • Make sure you are up-to-date on immunizations.

More Information

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Young adults value health insurance, poll



By Jordan Rau

A strong majority of young adults, whose participation in the health law may be key to its success or failure, strongly believe health insurance is important for them and worth the money, according to a new poll.

As some states and the federal government prepare new online marketplaces for people to purchase insurance this fall, the willingness of young people to buy coverage has been a topic of great uncertainty.

Their participation in these marketplaces is considered crucial, since the young tend to be healthier than older people and, therefore, will use fewer medical resources, allowing their premiums to help subsidize the care of the old and sick.

Among age groups, the young are considered the hardest sell on insurance, because the coverage mandated under the 2010 health law is more comprehensive — and therefore more expensive — than the catastrophic policies that many now obtain.

Young adults are considered more likely to believe they won’t suffer any horrible illnesses or injuries — a trend that has led to them being labeled “young invincibles.”

The poll found some reason to believe that the young may not shun the health law requirement that they hold insurance starting next January.

More than 71 percent of adults 30 or younger say having health insurance is “very important to them,” according to the poll from the Kaiser Family Foundation. (KHN is an independent program of the foundation.)

When the pollsters put the question differently by asking whether “insurance is something I need,” more than 74 percent of people under age 30 agreed.

Two-thirds of those 30 or younger agreed with the statement that “insurance is worth the money it costs,” although the pollsters did not offer those polled any dollar figures for an estimated cost.

Liz Hamel, an associate director of the foundation’s polling unit, said the goal of the question was to elicit people’s general attitude toward insurance cost, not to attempt to predict whether they would ultimately take up coverage.

In addition, she said, it would be hard to offer a set figure for premiums, given that they will vary among states and the size of a person’s family.

Also, two-thirds of these young adults said they worried about paying medical bills in the case of a serious illness or accident, and more than 44 percent said they were concerned about medical bills from routine care.

“The large majority of Americans want and value health insurance,” the pollsters wrote. “More than seven in ten young adults – a special focus of outreach and enrollment efforts — say it is very important to them personally to have insurance. Cost remains the biggest barrier for the uninsured, with four in ten citing the expense of coverage as the main reason they don’t have it.”

The poll also indicated that the Obama administration, states and health care advocates have much to do to make people aware of the new health insurance exchanges that are being created for people who don’t get coverage through an employer.

Forty-five percent of people polled said they had heard “nothing at all” about these marketplaces, and 34 percent said they had heard “only a little.”

Low-income people and the uninsured knew less about the marketplaces than did their more affluent and covered counterparts, the poll found.

The poll found that once again opposition to the health care law is greater than support by a margin of 43 percent to 35 percent. The poll also found that names matter significantly in this discussion.

Calling it “Obamacare” rather than the “health reform law” pushes the partisan buttons, causing more Democrats to say they favor it and more Republicans to say they oppose it.

Most substantially, the number of Democrats saying they favor Obamacare is 73 percent, while only 58 percent of Democrats favor the “health reform law.”

Republican opposition to the law rises by 10 percentage points if it is called “Obamacare,” with 86 percent of Republicans taking a dim view of the nicknamed program.

The survey was conducted June 4 through June 9 among 1,505 adults through landlines and cell phones. The margin of error is +/- 3 percentage points, with higher margins for subgroups.


This article was reprinted from 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.


A new way to spare dying patients from unwanted treatment


EKG tracingBy Michael Ollove
Stateline Staff Writer

The emergency call came in at 10:47 on a Saturday night: “Woman in Overland Park with difficulty breathing. Code one closest.”

Angela Fera, a paramedic in Johnson County, Kan., and her partner raced to the house, sirens blaring. When they arrived, six minutes after the first dispatch, a man told them that his 62-year old wife had terminal cancer and was unconscious.

The paramedics found her sitting upright in bed, ghostly pale with a weak pulse and shallow breathing. Death seemed imminent.

The woman was under hospice care, and had signed a “Do Not Resuscitate (DNR)” order. She had made her wishes clear: She did not want to be taken to the hospital if a life-threatening medical emergency arose.

But the woman was not in cardiac arrest, the situation specified in the DNR order. Protocol required that Fera try to save her life, probably by inserting a plastic tube into her trachea to restore breathing and transporting her to a hospital, where she’d be put on a ventilator.

Fera guessed that was precisely what the woman did not want. But the husband felt that his wife’s children—his stepchildren—should be the ones to decide whether to withhold treatment.

“We were completely fighting all our instincts to jump in and save her, but on the other hand we really wanted to do what was right,” Fera recalled.

New End-Of-Life Document

A new end-of-life document, more explicit and binding than a DNR and advanced directives, is designed to clarify patients’ wishes—and spare caregivers such as Fera from facing such wrenching choices.

A “physician order for life-sustaining treatment” (POLST) is a medical order, signed by a doctor or other authorized medical provider. The product of a conversation between patient and provider, a POLST specifies a patient’s goals and desires as death closes in.

Unlike a traditional DNR, it covers such medical interventions as resuscitation, hospitalization, use of antibiotics, hydration, intubation and mechanical breathing ventilation.

Without much opposition or attention, many states have adopted POLSTs. This year, Indiana and Nevada approved legislation to allow their use, leaving only seven states and the District of Columbia without POLSTs in at least some stage of development.

They tend to come in garish colors—neon pink, orange, and green, for example—so they stand out among other documents in a home. People are encouraged to put them on their refrigerators, and paramedics are trained to look for them there.

In Oregon, where POLSTs originated in the early 1990s, they are recorded in an electronic registry so first responders can access them online. Other states are moving in the same direction.

Research suggests POLSTs are effective in matching treatments to patients’ wishes. According to one study, patient preferences noted on POLST forms matched the actual treatment—or non-treatment—in more than nine out of 10 cases.

Vague or Irrelevant

Dr. Susan Tolle, one of the creators of POLST and director of the Center for Ethics in Health Care at the Oregon Health and Science University, said DNRs and other end-of-life documents tend to be vague or irrelevant to many medical situations. In many cases, they are signed by somebody whose authority may be in question during a medical crisis.

“We needed a portable system of actionable medical orders that would follow the patient and be consistently respected across settings of care, whether that was in a long-term nursing care facility, home, hospice, the ambulance or an acute care hospital,” Tolle said.

POLSTs are often confused with advanced directives, but they differ in significant ways. An advanced directive is often completed by a healthy person, and is purely hypothetical. It lacks the  medical authority of a physician’s signature.

By contrast, a POLST is completed by a medical provider in consultation with the patient. POLSTs are geared toward severely ill patients who are expected to die within a year.

According to Tolle, the most common triggers for completing a POLST are when someone begins hospice care, is admitted to a skilled nursing facility or is discharged from the hospital where they had a DNR order.

Some Are Wary

All states require a medical provider to sign a POLST. In most, the signer must be a physician, though some states allow other medical personnel, such as nurse practitioners, to sign it.

Most states also require the signature of the patient or a designated surrogate but some, such as Oregon and New York, do not.

Some disability rights groups have focused on the issue of patient signatures. Without one, according to Diane Coleman, president of the disability rights group Not Dead Yet, “How do we know the POLST medical order actually reflects the desires of the individual?”

Coleman worries that depending on how POLSTs are presented, they can make life-sustaining treatments—such as the use of feeding tubes—seem unbearable, even though many disabled people are able to live full lives because of them.

Disabled rights groups lobbied successfully against POLST in Connecticut this year.

In Texas, Wisconsin and Florida,  opposition to POLSTs has come from Catholic groups. Edward Furton of the National Catholic Bioethics Center worries that in cases where POLSTs do not cover the exact circumstances of the moment, denying care may be akin to euthanasia.

“When you look at the POLST documents, they don’t take into account the circumstances that the person is in at that particular time and place,” Furton said.

Nonetheless, there is no monolithic Catholic position on POLST. POLSTs have received strong Catholic support in some states, including California and Louisiana.

“This is not about ideology or religious views,” said John Carney, president of the Center of Practical Bioethics in Kansas City, which has worked to bring POLST to Missouri and Kansas. “This is about dignity and making decisions about what I want about my own life.”

Fera’s Choice

At the scene of the emergency in Overland Park a year ago, Fera the paramedic had to act fast: She asked the husband of the unconscious woman to summon his stepchildren and a nurse from the hospice service. Then she directed the fire crew to use a bag valve mask to help the woman breathe for a short time.

When the woman’s children and the nurse arrived, they quickly confirmed that the stricken woman had repeatedly said she didn’t want to be revived in such a situation.

With that assurance, plus approval via radio from an emergency room doctor, Fera and her partner left the woman at home in the care of the hospice nurse. They drove off, certain that the woman’s end was near, and fairly sure that they had acted according to her wishes.

Fera is grateful that she is less likely to face similar situations in the future. In the year since responding to the call in Overland Park, Johnson County has adopted POLSTs. “To say we like it,” she said, “is an understatement.”
Stateline logo

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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Use of health and fitness apps explodes – but which ones work?


Fitness palBy Martha Bebinger, WBUR

Christine Porter is hooked on the My Fitness Pal app. In October, after deciding to lose 50 pounds, Porter started typing in everything she eats, drinks and any exercise she gets.

“This is like my main page here,” says Porter, who lost 42 pounds in nine months. “It’s telling me I have about 1,200 calories remaining for the day. When I want to record something I just click the ‘add to diary’ button. I’m on it all day either through my phone or through the computer.”

Health apps such as My Fitness Pal are turning smartphones and tablets into exercise aides, blood pressure monitors and devices that transmit an EKG.

And the day is not far off when doctors may be suggesting apps along with prescribing drugs to help patients manage their health. But the explosion of apps is way ahead of tests to determine which ones work.

Porter heard about the app from Ryan Sherman, her health coach at a clinic for employees of Massachusetts General Hospital. Sherman helps clients turn a doctor’s orders into a user friendly action plan for keeping high blood pressure or sugar levels in check.

Increasingly, says Sherman, patients with diabetes or heart problems are coming in, pulling out their phones, and saying hey, have you seen this app?

“There’s a new one every day, so it’s trying to keep up with that,” Sherman says.

Which is one reason why many doctors are suggesting, but not prescribing apps. Doctors aren’t sure which of the roughly 40,000 available apps do what they claim to do.

The U.S. Food and Drug Administration divides health apps into two categories: those that help with healthy lifestyles and those that turn your phone into a medical device to, say, record blood pressure or an EKG, and then send those readings to a doctor.

The FDA is revising regulations for apps in the medical device category. It does not plan to regulate diet or exercise apps. A few private companies are stepping in to do that task. Ben Chodor started Happtique, a company that reviews apps and gives those are at least perform correctly, a seal of approval.

“It’s the Wild West and someone needs to come in and at least help the consumers and the clinicians and the payers sort through the 40,000-plus apps that are already out there,” says Chodor.

Happtique will not say which apps work better than others or guarantee their safety. Still, some doctors say apps that work are transforming medicine.

Dr. Eric Topol, the chief academic officer at Scripps Health in San Diego, says apps that monitor blood pressure or glucose rates can be more valuable than prescriptions to keep these conditions in check.

“When we use a medication we don’t know if it’s going to work or not.  It’s much better when a person’s taking their blood pressure on a frequent basis,” says Topol.

Some apps work with another device, such as when a person wears a blood pressure monitor tha transmits the data to the person’s phone. “The average person looks at their smart phone 150 times a day,” says Topol. “All of a sudden, they’re able to diagnose if their blood pressure’s adequately controlled and what are the circumstances when it’s not.”

Topol says apps that control blood pressure will help prevent strokes and heart attacks and may mean doctors should prescribe phones and tablets in addition to apps. But Dr. Laura Ferris at the University of Pittsburgh, urges patients to use apps cautiously.

“It does make sense that people who download these apps and use them really understand that they are doing so at their own risk,” says Ferris.

Ferris ran a study of apps that claim to detect cancer based on a picture of a mole. Only one of the apps sends the  picture of your suspicious mole to a dermatologist. It was right 98 percent of the time.

Three others, says Ferris, could be dangerously wrong: “The best of them missed melanoma 30 percent of the time. The worst of them missed melanoma over 90 percent of the time.”

Despite the growing interest in medical apps, there are many unresolved questions about their use: Should all the information patients collect become part of their medical record and how? Who in the doctor’s office analyzes patients’ numbers? Will insurers cover the cost of apps?

Dr. Ben Crocker, at the Mass General clinic that is testing a few apps, says those are questions doctors will have to answer.

“This is what’s engaging patients,” says Crocker. “Patients are coming to their doc for the first time saying, ‘I’ve been collecting some information or I’ve been using this application.’  And that, I think we can’t ignore no matter where this is taking us, no matter how Wild West it feels.”

This story is part of a partnership that includes WBURNPR, and Kaiser Health News.

This article was reprinted from 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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Trying to lose weight? Watch what you drink.


Rethink Your Drink

From the US Centers for Disease Control and Prevention

When it comes to weight loss, there’s no lack of diets promising fast results. There are low-carb diets, high-carb diets, low-fat diets, grapefruit diets, cabbage soup diets, and blood type diets, to name a few.

But no matter what diet you may try, to lose weight, you must take in fewer calories than your body uses. Most people try to reduce their calorie intake by focusing on food, but another way to cut calories may be to think about what you drink.


Photo courtesy of Richard Dudley

What Do You Drink? It Makes More Difference Than You Think!

Calories in drinks are not hidden (they’re listed right on the Nutrition Facts label), but many people don’t realize just how many calories beverages can contribute to their daily intake.

As you can see in the example below, calories from drinks can really add up. But there is good news: you have plenty of options for reducing the number of calories in what you drink.

Occasion Instead of… Calories Try… Calories
Morning coffee shop run Medium café latte (16 ounces) made with whole milk 265 Small café latte (12 ounces) made with fat-free milk 125
Lunchtime combo meal 20-oz. bottle of nondiet cola with your  lunch 227 Bottle of water or diet soda 0
Afternoon break Sweetened lemon iced tea from the vending machine (16 ounces) 180 Sparkling water with natural lemon flavor (not sweetened) 0
Dinnertime A glass of nondiet ginger ale with your meal (12 ounces) 124 Water with a slice of lemon or lime, or seltzer water with a splash of 100% fruit juice 0 calories for the water with fruit slice, or about 30 calories for seltzer water with 2 ounces of 100% orange juice.
Total beverage calories: 796


(USDA National Nutrient Database for Standard Reference)

Substituting no- or low-calorie drinks for sugar-sweetened beverages cuts about 650 calories in the example above.

Of course, not everyone drinks the amount of sugar-sweetened beverages shown above. Check the list below to estimate how many calories you typically take in from beverages.

 Type of Beverage Calories in 12 ounces Calories in 20 ounces
Fruit punch 192 320
100% apple juice 192 300
100% orange juice 168 280
Lemonade 168 280
Regular lemon/lime soda 148 247
Regular cola 136 227
Sweetened lemon iced tea (bottled, not homemade) 135 225
Tonic water 124 207
Regular ginger ale 124 207
Sports drink 99 165
Fitness water 18 36
Unsweetened iced tea 2 3
Diet soda (with aspartame) 0* 0*
Carbonated water (unsweetened) 0 0
Water 0 0
*Some diet soft drinks can contain a small number of calories that are not listed on the nutrition facts label.
( USDA National Nutrient Database for Standard Reference)

Milk contains vitamins and other nutrients that contribute to good health, but it also contains calories. Choosing low-fat or fat-free milk is a good way to reduce your calorie intake and still get the nutrients that milk contains.

Type of Milk Calories per cup (8 ounces)
Chocolate milk (whole) 208
Chocolate milk (2% reduced-fat) 190
Chocolate milk (1% low-fat) 158
Whole Milk  (unflavored) 150
2% reduced-fat milk (unflavored) 120
1% low-fat milk (unflavored) 105
Fat-free milk (unflavored) 90
*Some diet soft drinks can contain a small number of calories that are not listed on the nutrition facts label.
( USDA National Nutrient Database for Standard Reference)

Learn To Read Nutrition Facts Labels Carefully

Be aware that the Nutrition Facts label on beverage containers may give the calories for only part of the contents. The example below shows the label on a 20-oz. bottle.

As you can see, it lists the number of calories in an 8-oz. serving (100) even though the bottle contains 20 oz. or 2.5 servings. To figure out how many calories are in the whole bottle, you need to multiply the number of calories in one serving by the number of servings in the bottle (100 x 2.5).

You can see that the contents of the entire bottle actually contain 250 calories even though what the label calls a “serving” only contains 100.

This shows that you need to look closely at the serving size when comparing the calorie content of different beverages.

Serving Size 8 fl. oz.
Servings Per Container     2.5
Amount per serving
Calories         100

Sugar by Any Other Name: How To Tell Whether Your Drink Is Sweetened

Sweeteners that add calories to a beverage go by many different names and are not always obvious to anyone looking at the ingredients list. Some common caloric sweeteners are listed below.

If these appear in the ingredients list of your favorite beverage, you are drinking a sugar-sweetened beverage.

  • High-fructose corn syrup
  • Fructose
  • Fruit juice concentrates
  • Honey
  • Sugar
  • Syrup
  • Corn syrup
  • Sucrose
  • Dextrose

High-Calorie Culprits in Unexpected Places

Coffee drinks and blended fruit smoothies sound innocent enough, but the calories in some of your favorite coffee-shop or smoothie-stand items may surprise you.

Check the Web site or in-store nutrition information of your favorite coffee or smoothie shop to find out how many calories are in different menu items.

And when a smoothie or coffee craving kicks in, here are some tips to help minimize the caloric damage:

At the coffee shop:

  • Request that your drink be made with fat-free or low-fat milk instead of whole milk
  • Order the smallest size available.
  • Forgo the extra flavoring – the flavor syrups used in coffee shops, like vanilla or hazelnut, are sugar-sweetened and will add calories to your drink.
  • Skip the Whip. The whipped cream on top of coffee drinks adds calories and fat.
  • Get back to basics. Order a plain cup of coffee with fat-free milk and artificial sweetener, or drink it black.

At the smoothie stand:

  • Order a child’s size if available.
  • Ask to see the nutrition information for each type of smoothie and pick the smoothie with the fewest calories.
  • Hold the sugar. Many smoothies contain added sugar in addition to the sugar naturally in fruit, juice, or yogurt. Ask that your smoothie be prepared without added sugar: the fruit is naturally sweet.

Better Beverage Choices Made Easy

Now that you know how much difference a drink can make, here are some ways to make smart beverage choices:

  • Choose water, diet, or low-calorie beverages instead of sugar-sweetened beverages.
  • For a quick, easy, and inexpensive thirst-quencher, carry a water bottle and refill it throughout the day.
  • Don’t “stock the fridge” with sugar-sweetened beverages. Instead, keep a jug or bottles of cold water in the fridge.
  • Serve water with meals.
  • Make water more exciting by adding slices of lemon, lime, cucumber, or watermelon, or drink sparkling water.
  • Add a splash of 100% juice to plain sparkling water for a refreshing, low-calorie drink.
  • When you do opt for a sugar-sweetened beverage, go for the small size. Some companies are now selling 8-oz. cans and bottles of soda, which contain about 100 calories.
  • Be a role model for your friends and family by choosing healthy, low-calorie beverages.

 Photo courtesy of Richard Dudley




How has health reform affected businesses in Massachusetts?


Map of BostonBy Kathleen O’Connor
Publisher of the O’Connor Report

In 2006, Massachusetts passed health care legislation that is remarkably similar to the Affordable Care Act (ACA).  Like the ACA, the Massachusetts law focused on expanding health insurance for all the state’s 6.5 million residents.

Key provisions of the law included:

  • Expanding public programs that are affordable
  • Requiring adults to buy insurance or pay a fine
  • Requiring employers with 11 or more full time employees to meet a  minimum standard of coverage or pay an annual assessment of up to $295 per employee to help fund costs of uncompensated care.  This has now been amended to apply to companies with 21 or more fulltime employees in 2013.
  • Creating an insurance exchange—the Health Connector—making it easy for individuals and small businesses to find affordable insurance.

The arguments against this bill echo what is being said now—that small businesses cannot afford the reform; that businesses would pay the fine rather than offer insurance; that small employers would dump insurance. This is not what happened.

Since the law passed in 2006:

  • Nearly 2/3rd of Massachusetts residents continue to support the law
  • Physician support is even higher at 70%
  • Physicians say the quality of care has improved—19%;  while 66% are neutral about the impact on quality; only 6% think the law has a negative impact
  • Massachusetts has the lowest rate of uninsured in the country
  • In 2006, 6.4%  Massachusetts residents were uninsured, compared to 1.9% in 2010
  • More employers offer insurance—77% today vs. 70% in 2005.

Some Consequences of health care reform:

  • Rapid adoption of “global or bundled” contracts that reward physicians and hospitals for quality and efficiency
  • Health insurance products allow employers and consumers to use certain lower cost providers
  • Stronger incentives exist for hospital systems and physician groups to reduce cost while improving care
  • Premiums in the non-group market fell considerably and employer premium rates have risen more slowly in Massachusetts than in the rest of the country
  • Employers did not drop their insurance coverage as feared.  Since reform, employer sponsored coverage has grown from 64% to 68%.

What the Massachusetts experience tells us is that reform can work, and that it is more likely to work if groups work together.  The law was passed when Mitt Romney (R) was governor, but he faced a 2/3 majority of Democrats in both the House and Senate.

There were also several coalitions in Massachusetts at the time, including Massachusetts Business Leaders for Quality Affordable Health Care and Affordable Care Today Coalition of business, labor, faith communities and consumer groups.

In King County, County Executive Dow Constantine has just appointed a Leadership Circle to help with outreach and education for the Affordable Care Act.  The three co-chairs are Maud Daudon, CEO, Metropolitan Seattle Chamber of Commerce; Tom Gibbon, MD, External Affairs and Manager, Swedish Community Specialty Clinic; and Gordon McHenry. Executive Director, Solid Ground, a non-profit organization working with low income communities.

Information for this article came from a presentation at Seattle CityClub with presenters including Maud Daudon,  CEO Metropolitan Seattle Chamber of Commerce and Phil Edmondson, CEO, William Gallagher Associates and co-founder of Massachusetts’ Affordable Care Today Coalition, and Business Community Participation in Health Reform:  The Massachusetts Experience, 2013, pamphlet  prepared by Associated Industries of Massachusetts, Massachusetts Business Roundtable, Greater Boston Chamber of Commerce and Massachusetts Taxpayer Foundation.

Kathleen O’Connor, MA: O’Connor, publisher of the O’ConnorReport, has nearly 30 years experience in health care reform publishing and consulting, reform strategies, and consumer advocacy locally and nationally.  She is a member of the Association of Health Care Journalists.


Where to find answers to questions about health insurance


Question marksBy Michelle Andrews

About half of Americans say they don’t know how the Affordable Care Act will affect them. Four in 10 think it has been repealed or overturned, or they are unsure where it stands.

So chances are good that when the major provisions kick in next year, including online health insurance marketplaces and new standards for health plan costs and coverage, people are going to have questions. Lots of questions. When they do, the biggest one of all may be where to turn for answers.

There may not be a simple solution. Depending on where people live and the type of coverage they have, the assistance that’s available and where to find it may vary considerably.

Health policy experts and consumer advocates “are concerned about consumers falling through the cracks and not having clear information about where to go for what,” says Sabrina Corlette, a research professor who directs Georgetown University’s Center on Health Insurance Reforms.

It wasn’t supposed to be this way. The health-care overhaul envisioned a nationwide network of state-run Consumer Assistance Programs, or CAPs, supported by federal funds.

Building on existing state insurance department programs and community-based services, the CAPs would provide one-stop health insurance assistance for people with private coverage and would advocate on their behalf with insurers.

In the politically charged atmosphere surrounding the passage of the health-care law, however, 15 states with Republican governors refused to apply for CAP grants, and two more returned their funding after Republican governors were elected, according to a Health Affairs study published in February.

Program funding has been inadequate, experts say. Following an initial $30 million appropriation for CAP in 2010, the Department of Health and Human Resources awarded nearly $20 million two years later, in August 2012.

In contrast, the annual budget for the Medicare program’s help line is $250 million, the Health Affairs study noted.

Some states have been creative about patching together CAP funding, says Karen Pollitz, a research fellow at the Kaiser Family Foundation. But funding uncertainty continues.

Consumer Assistance Programs are operating in 21 states, including Maryland, and in the District. The quality of the assistance provided through these and other assistance programs varies widely, says Mark Schlesinger, a professor of health policy at Yale who co-authored the Health Affairs study.

Some of the programs are aggressive advocates for consumers, he says. In other states, however, “they’re explaining the law rather than advocating for people.”

Angela Gavin of Troy, N.Y., turned to the program for guidance sorting through an insurance dispute and found the program helpful. When Gavin, 58, had a colonoscopy in February to screen for colorectal cancer, her insurer said she owed $1,150 of the $4,745 bill.

The insurer said that because the doctor had found and removed a polyp, the procedure was no longer a routine screening and she would have to pay a portion of the cost.

But under the ACA, preventive cancer screenings such as colonoscopies are covered without patient cost-sharing even if a polyp is found.

Gavin noticed an 800 number at the bottom of her insurance form for Community Health Advocates, which runs New York’s CAP. An advocate at the program worked with Gavin to file an appeal. She’s awaiting the result.

“Thank God for that 1-800 number at the bottom of the form, because otherwise I would probably just have paid the bill,” Gavin says. “I wouldn’t have known what to do.”

Consumers can check the federal government’s Web site for links to CAPs and other insurance assistance programs in their state.

State insurance departments can help consumers with questions. But they often see their role as mediating between insurers and consumers rather than advocating for individuals, experts say.

In some states, community-based organizations
also offer insurance help.

Individuals and small businesses that are considering seeking coverage from state-based health insurance marketplaces can contact those exchanges directly with questions about plans or eligibility for subsidies.

The ACA requires all exchanges to have community-based “Navigator” programs to help people learn about plans offered through the exchanges and about eligibility for subsidies. Grants for these programs will be announced later this summer.

In addition, each exchange is required to operate a toll-free call center. Some exchanges, like the one planned for the District, aim to provide comprehensive health insurance assistance.

“We are building our call center to handle all sorts of questions,” says Mila Kofman, executive director of the District’s Health Benefit Exchange Authority. “Whether it’s about enrollment through the exchanges, tax credits, Medicaid or a problem with their health plan, we’ll be a one-stop shop where consumers can come.”

The assistance available at other exchanges may be more bare-bones, experts say.

Pollitz suggests that people shopping for insurance on an exchange start investigating plans and applying for coverage in October, the first month people can sign up for exchange coverage that will begin Jan. 1. “You don’t want to wait until the last minute.”

Please send comments or ideas for future topics for the Insuring Your Health column to

This article was reprinted from 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.