Sunday, April 14, 2013

Cut the salt, but add potassium To get the full benefit of decreasing sodium in your diet, you also need to increase the potassium you consume. (Sun, 4/14) The People’s Pharmacy Did skipping suds spread cold? People’s Pharmacy on a nurse who did not wash his hands and spread a cold; Listerine works for reader with acne. (Sun, 4/14) Med schools teaching courses on LGBT patient care Lesbian, gay, bisexual and transgendered patients pose different challenges for doctors, starting with language and trust. Universities are developing courses to make doctors more effective. (Sun, 4/14) One healthful thing we love Tulip Pedal, benefitting the Skagit County Medic One Safe Kids injury prevention program. (Sun, 4/14) Medicare increase could ding some in middle class  Retired city worker Sheila Pugach lives in a modest home on a quiet street in Albuquerque, N.M., and drives an 18-year-old Subaru.(Sat, 4/13) Fit For Life Let your injury be your guide to working out It’s hard to generalize about injuries, because healing time depends on how fit you are and how active you remain after the injury. But it’s wise to follow a few basics. (Fri, 4/12) FDA warns about workout booster with stimulant DMAA Since early 2008, the Food and Drug Administration has received reports of at least five deaths in consumers who used products containing dimethylamylamine, or DMAA. (Fri, 4/12)

Mental-health care amendments may heal rifts in Senate gun-control bill 

Proponents say the plans, which stand a good chance of being included in any final gun-control bill, would lead to some of the most significant advancements in treating mental illness in years and address a problem that people on both sides of the issue agree is a root cause of rampages. (Fri, 4/12)  Fit & Fun A ‘Wetlands Wakeup’ nature walk A “Wetlands Wakeup” nature walk for families takes place Saturday, March 13, 2013, at Magnuson Park in Seattle. (Thu, 4/11) Seattle study: Doctors getting comfortable with Death With Dignity A new study by a Seattle Cancer Care Alliance oncologist says doctors are becoming more comfortable with the state’s 4-year-old Death With Dignity law, in part because so few patients are choosing to use the law to end their lives. (Thu, 4/11) See-through brains offer scientists a clearer view of disease  The Clarity technique ushers in a new era of brain imaging, offering hope for improving the study of such neurological disorders as autism, schizophrenia, Alzheimer’s disease and Parkinson’s disease. (Wed, 4/10) U.S. says preemie study didn’t fully disclose risks The informed-consent document that parents had to sign to enroll in the study for very premature infants failed to spell out all the risks, according to the government’s Office for Human Research Protections. (Wed, 4/10) Alzheimer’s study focuses on genes, African-Americans Black people with a certain genetic variant may face a higher risk of late-developing Alzheimer’s disease, a study found. (Tue, 4/09) Alcohol increases risk of breast cancer but helps survivors live longer While alcohol consumption is considered a risk for getting breast cancer, moderate drinking holds cardiovascular benefits that can increase longevity for the cancer survivors, says a new study from the Fred Hutchinson Cancer Research Center. (Mon, 4/08) UN: Chemical investigators ready to go to Syria  U.N. experts are ready to move into Syria immediately to investigate reported chemical weapons attacks but President Bashar Assad’s government still has not approved their entry, U.N. Secretary-General Ban Ki-moon said Monday. (Mon, 4/08) WHO talks with China on sending bird flu team  The World Health Organization is talking with the Chinese government about sending international experts to China to help investigate a new bird flu strain that has sickened at least 24 people, killing seven of them. (Mon, 4/08) Dengue cases may be 4 times more common than known  There may be nearly four times as many people infected with the tropical disease dengue globally than was previously believed, according to a new study. (Sun, 4/07) Cancer treatment ‘medical arms race’ Hospitals scramble for dominance by investing millions of dollars in technology that has not been proven to be better than cheaper alternatives for some cancers. (Sun, 4/07) Vancouver teen survives sudden cardiac arrest; many don’t A seemingly healthy young person suffers sudden cardiac arrest every three days in the U.S. It’s the leading cause of death on school property, but 18-year-old Heidi Stewart, of Vancouver, Wash., survived hers. (Sun, 4/07) 


FDA warns customers to avoid stimulant found in popular supplements


DMAAThe US Food and Drug Administration is warning consumers to avoid products containing the stimulant dimethylamylamine (DMAA), an ingredient found in many supplements that claim promote weight loss and performance enhancement.

The compound “can elevate blood pressure and could lead to cardiovascular problems, including heart attack, shortness of breath and tightening of the chest,” the FDA warns, and has been

FDA has warned companies known to be using DMAA in dietary supplements that those products containing this ingredient are illegal.

Here is the FDA Consumer Update on DMAA and a Q&A on DMAA in Dietary Supplements

Stimulant potentially dangerous to health, FDA warns

FDA Consumer Update

The Food and Drug Administration (FDA) is using all available tools at its disposal to ensure that dietary supplements containing a stimulant called dimethylamylamine (DMAA) are no longer distributed and available for sale to consumers in the marketplace.

The ingredient, DMAA, is most commonly used in supplements promising weight loss, muscle building and performance enhancement; it can elevate blood pressure and could lead to cardiovascular problems, including heart attack, shortness of breath and tightening of the chest. Given the known biological activity of DMAA, the ingredient may be particularly dangerous when used with caffeine.

As of April 11, 2013, FDA had received 86 reports of illnesses and death associated with supplements containing DMAA. The majority are voluntary reports from consumers and healthcare practitioners.

The illnesses reported include heart problems and nervous system or psychiatric disorders. Note, however, that a report is not proof that the product actually caused the problem.

FDA has warned companies known to be using DMAA in dietary supplements that those products containing this ingredient are illegal.

Such warnings offer the quickest way at FDA’s disposal to halt the further distribution of dietary supplements containing DMAA in the marketplace.

In fact, all but one of the companies sent a Warning Letter have agreed to stop using DMAA as an ingredient in their dietary supplements.

The one company that has yet to agree to such action, USPLabs, has responded to FDA’s warning by submitting published studies that purport to challenge FDA’s conclusions.

However, after reviewing the studies provided by USPLabs, FDA has found the information insufficient to defend the use of DMAA as an ingredient in dietary supplements.

FDA is finalizing a formal response to the firm to reflect its findings, according to Daniel Fabricant, Ph.D., director of FDA’s Division of Dietary Supplement Program.

FDA’s authority over dietary supplements is very different from its authority over drugs and other medical products. FDA is required to undertake what are usually lengthy scientific and legal steps in order to force the removal of dietary supplements that may be unsafe or are otherwise illegal if companies don’t voluntarily comply.

As FDA continues the process needed to get DMAA off the market, the agency is urging consumers to check labels and avoid any dietary supplements containing DMAA, which is referred to on different product labels by 10 possible names. The alternatives are listed at FDA’s DMAA web page.

The Challenge

FDA’s response to the use of DMAA illustrates the challenges that the agency faces in addressing incidents involving potentially dangerous dietary supplements. The effort is increasingly important as the use of dietary supplements increases worldwide. A 2011 study found that more than half of U.S. adults used a dietary supplement between 2003 and 2006, compared to 40% between 1988 and 1994.

In recent years, FDA has alerted consumers to hundreds of tainted products marketed as dietary supplements. Consumers should be aware that dietary supplements are subject to different oversight than drugs and other medical products.

“Consumers may mistakenly look at a capsule and think that FDA has signed off on that product as safe and effective prior to that product appearing on the market, as we do with drugs and other medical products,” says Fabricant. “In contrast, with dietary supplements, there is no pre-market approval, and once a product is on the market, the burden is on the FDA to prove that a product is unsafe.”

FDA’s role in overseeing dietary supplements is laid out in a 1994 law and subsequent amendments. FDA’s enforcement capabilities range from issuing warning letters seeking voluntary cooperation—the quickest way to get a product off the market—to bringing criminal charges.

In recent years, FDA enforcement actions involving dietary supplements have included banning products, executing injunctions, working with U.S. marshals to seize products, and issuing safety alerts and consent decrees—which are agreements approved and enforced by a federal court.

In many cases, FDA has acted when dietary supplements were found to contain ingredients approved for use in prescription drugs. DMAA was approved in 1948 for use as a nasal decongestant, but the approval was withdrawn in 1983.

The products cited in the warning letter to USPLabs are Oxy Elite Pro and Jack3D. These products claim, among other things, to be fat-burning and performance-enhancing supplements, respectively. While action in that case in pending,

FDA is following up to ensure that other companies which promised to cease using DMAA as an ingredient in their dietary supplements are actually doing so.

FDA is also looking to see if there are other dietary supplement products containing DMAA in the marketplace, and will continue to act to ensure that such products, when identified, are no longer distributed and available for sale to consumers.

Consumers are urged to report any problems associated with supplement use to the company or the agency, and to always consult with their health care professional before using a supplement.

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

April 11, 2013


Q & A on DMAA in Dietary Supplements

DMAA in Dietary SupplementsDMAA, also known as 1,3-dimethylamylamine, methylhexanamine or geranium extract, is an ingredient found illegally in some dietary supplements and often touted as a “natural” stimulant. DMAA, especially in combination with other ingredients such as caffeine, can be a health risk to consumers. Ingestion of DMAA can elevate blood pressure and lead to cardiovascular problems ranging from shortness of breath and tightening in the chest to heart attack. Dietary supplements containing DMAA are illegal and FDA is doing everything within its authority to remove these products from the market. FDA has issued warning letters to companies notifying them products with DMAA need to be taken off the market or reformulated to remove this substance. Most companies warned are no longer distributing products with DMAA. While FDA is working to get these products off the market, consumers should not buy or use any dietary supplement product containing DMAA.

For more information:

Questions & Answers

What is DMAA?

DMAA (1,3-dimethylamylamine) is an amphetamine derivative that has been widely used in sports supplements sold in the United States. Also known as methylhexanamine or geranium extract, DMAA is often touted as a “natural” stimulant, with many claimed functional uses including a body-building aid, an athletic performance enhancer, and a weight-loss aid. Although DMAA at one time was approved as a drug for nasal decongestion, no medical use of DMAA is recognized today. FDA is not aware of any reliable science indicating that DMAA exists naturally in plants.

DMAA-containing dietary supplements are illegal and their marketing violates the law. Based on the scientific information reviewed by FDA, DMAA is not a dietary ingredient.

Is it safe to consume DMAA?

No, FDA does not have any information to demonstrate that consuming DMAA is safe. FDA is very concerned about DMAA and we advise consumers not to purchase or use any dietary supplement containing DMAA. This substance narrows blood vessels and arteries, which can elevate blood pressure, and may lead to cardiovascular problems such as shortness of breath, arrhythmias, tightening in the chest, and heart attack, as well as seizures and other neurological and psychological conditions. FDA has received 86 reports of adverse events involving products containing DMAA. These events include psychiatric disorders, heart problems, nervous system disorders, and death.

How does FDA regulate ingredients in dietary supplements like DMAA?

The law requires companies to notify FDA when they intend to market a dietary supplement containing a New Dietary Ingredient (NDI) in the United States, if the NDI has not been used in the food supply in the same chemical form.  An NDI is a dietary ingredient that was not marketed in a dietary supplement prior to October 15, 1994. Unlike drugs, dietary supplements do not have pre-market approval for safety or effectiveness. If a safety issue arises post-market, FDA can investigate and take steps to remove products that may be unsafe from the market. However, in order for FDA to ban a compound in a dietary supplement, FDA is required under the statute to undertake a series of lengthy scientific and legal steps. In the interim, FDA can take direct action by issuing warning letters to industry to obtain removal of ingredients in dietary supplements and protect the public from potentially harmful products. FDA can also take a seizure action to remove products from the market or obtain an injunction against a company to prevent it from manufacturing and distributing illegal products.

What is FDA doing to remove DMAA-containing dietary supplements from the market?

FDA sent warning letters to a total of 11 companies advising them that DMAA-containing products marketed as dietary supplements are illegal and must be taken off the market or reformulated to remove DMAA. These 11 companies account for most of the DMAA products sold in the United States. This action was taken to protect consumers and get these products off the shelves as quickly as possible. To date, all but one of the companies warned by FDA have agreed to stop marketing products with DMAA. FDA is in communication with the one remaining company to bring the issue to closure. FDA is also sending its investigators to the companies that agreed to reformulate or remove DMAA to verify that they have taken the appropriate action. Six companies have been visited so far. Five of the companies were in compliance and the sixth company, which was not in compliance, agreed to recall their product after discussions with FDA.

Why hasn’t the FDA banned this ingredient, especially after the U.S. military took it off their shelves?

The U.S. military initiated a temporary hold on the sale of DMAA-containing products in military exchanges. The law requires FDA to follow certain lengthy steps before the agency can ban dietary supplements containing DMAA. FDA has been working to remove dietary supplements containing DMAA from the marketplace and we will continue to look at all regulatory and legal options to bring companies into compliance and protect consumers.

How do consumers know if a dietary supplement contains DMAA?Consumers should look for DMAA listed on the product label. It may also be listed as:

  • 1,3-DMAA
  • 1,3-Dimethylamylamine
  • 1,3-Dimethylpentylamine
  • 2-Amino-4-methylhexane
  • 2-Hexanamine
  • 4-Methyl-2-hexanamine
  • 4-Methyl-2-hexylamine
  • 4-methyl- (9CI)
  • Dimethylamylamine
  • Geranamine
  • Methylhexanamine
  • Methylhexanenamine

Some products also will list Pelargonium graveolens extract or Geranium extract, which may indicate that the product contains DMAA.

What should consumers do if they believe they’ve been harmed by consuming DMAA?

Consumers can report incidents directly to FDA. See Dietary Supplements – Report an Adverse Event.

Consumers can also report these adverse events to the company whose name and contact information is on the product label.

In addition, consumers should contact their health care practitioner if they have suffered or are still being affected by an adverse event.

Doctor carrying a hospital piggy bank,   collecting money

Doctor-owned hospitals prosper under health law


hospital money 300By Jordan Rau
KHN Staff Writer

Doctor-owned hospitals are earning many of the largest bonuses from the federal health law’s new quality programs, even as the law halts their growth.

The hospitals, many of which specialize in heart or orthopedic surgeries, have long drawn the ire of federal lawmakers and competitors.

They say physicians often direct the best-insured and more lucrative cases to their own facilities, while leaving the most severely ill patients to others.

Some researchers say the doctors’ financial interests encourage them to perform more tests and procedures, driving up the cost of care. The health law halted construction or expansion of these hospitals except in unusual circumstances.

But physician-owned hospitals have emerged as among the biggest winners under two programs in the health law. One rewards or penalizes hospitals based on how well they score on quality measures. The other penalizes hospitals where too many patients are readmitted after they leave.

There are more than 260 hospitals owned by doctors scattered around 33 states, according to Physician Hospitals of America, a trade group. They are especially prevalent in Texas, Louisiana, Oklahoma, California and Kansas.

Of 161 physician-owned hospitals eligible to participate in the health law’s quality programs, 122 are getting extra money and 39 are losing funds, a Kaiser Health News analysis shows. That’s a stark contrast with other hospitals — 74 percent of which are being penalized.

Medicare is paying the average physician-owned hospital bonuses of 0.21 percent more for each patient during the fiscal year that runs through September, the analysis found. Meanwhile, the average hospital not run by doctors is losing 0.30 percent per Medicare patient.

Doctor-owned hospitals comprise nine of the 10 hospitals getting the largest bonuses in the fiscal year that begin last October, the data show. The top one is Treasure Valley Hospital in Boise, Idaho, a 10-bed hospital that boasts a low patient-to-nurse ratio and extra attention, right down to thank-you notes sent to each discharged patient.

Physicians who own their own hospitals say they are not surprised they have done so well under the program. “From our hospital, which did pretty well, the single-minded obsession with quality has been the hallmark of our success, and the value-based purchasing just reflects that,” said Dr. John Dietz, an orthopedist and part owner of Indiana Orthopaedic Hospital in Indianapolis, which is getting a 0.72 percent bonus. “It’s the difference between renting a home and owning a home: the pride of physicians in owning the hospital.”

But Jean Mitchell, an economist at Georgetown University’s Public Policy Institute who has documented patterns of patient cherry-picking among these hospitals, said Congress should have excluded them from the program. “This is a disgrace,” she said. “Talk about a law that’s backfired.”

Physician-owned hospitals are less likely to face penalties for high readmission rates, because many do not take the heart failure and heart attack cases that Medicare analyzes when determining whether to levy a penalty. They also tend to have far fewer low-income patients, KHN’s analysis shows.

It’s a population that is generally less able to buy medications, pursue follow-up appointments and find help while recuperating – problems that often send patients back to the hospital.

“These hospitals are on balance not seeing the same population,” said Dr. Daniel Podolsky, president of UT Southwestern Medical Center, a teaching hospital in Dallas. “A lot of that is the demographics and the geography.”

Dr. Ashish Jha, a professor at the Harvard School of Public Health, has documented how the readmission penalties are hitting safety net hospitals particularly hard. “Providing extra rewards for hospitals that treat the healthiest, wealthiest patients just seems unfair,” he said.

Past research has shown that physician-owned hospitals score highly in following basic clinical guidelines and pleasing patients — the factors that Medicare is using to determine bonuses and penalties in its “value-based purchasing” program.

Those successes are made easier by the fact that many of their patients come in for elective surgeries rather than emergencies, allowing for more orderly preparations than at a typical acute-care hospital.

“We do surgery and we do surgery well,” said Dr. Robb Linafelter, chief executive ofLincoln Surgical Hospital in Nebraska, which is getting a bonus of 0.78 percent on each Medicare patient payment. He said because the doctors own the hospital, they can direct resources to best serve patients.

His hospital offers single-bed rooms, interactive TVs and allows patients to order food from outside restaurants. “Those things are going to make the patient experience so much better,” he said. “At a community hospital, doctors don’t have control over where the dollars are spent.”

The narrow focus on these specialty hospitals also helps them excel, said Stacie Vance, chief of nursing operations at Indiana Orthopedic. “You don’t get too many athletes who play more than one sport,” she said. “It’s the same way with hospitals. If you’re allowed to specialize in something you can do one thing great. If you want to specialize in four or five things, you can probably do them okay.”

It’s unclear whether physician-owned hospitals will continue to benefit under the health law’s quality programs. Most were eligible to participate in the value-based program this year, but by some estimates, two-thirds or more of the physician-owned hospitals probably will not qualify for inclusion in the next fiscal year, which begins in October.

That’s because they may not have enough cases to have their mortality rates evaluated, a mandatory part of the program. However, almost all of the doctor-owned hospitals that were eligible this year are on track to regain eligibility in the third year of the program, which begins in October 2014, because the rules change again.

The actual amount of money involved for many of these hospitals this year is not substantial, because many have small caseloads of Medicare patients and the maximum bonuses are not enormous. “It’s not a significant amount, but I’ll take it,” Linafelter said. “It’s more of a recognition that we are a facility that is doing things right.”


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.

Seattle Children's Whale Logo

Teens and Sexual Assault, Part 7: Changing the Culture, One Teen at a Time


Seattle Children's Whale LogoBy
This article first appeared on Seattle Children’s Teenology 101 blog.

This is my last post on the topic of teens and sexual assault. I’m going to start with another story from my adolescence that will always stay with me.

I was 15, and had lied, finagled, and faked my way into an all-night party at my friend Hannah’s* house. The ages at this party ranged from 13-20 (first problem), Hannah’s mother was willing to tell parents she’d be there all night, but went to sleep early and never woke up (second problem), the house had a few acres of property, including cabins (third problem), and there was beer everywhere (fourth problem.)

The youngest girl at the party was named Silvia. She was 13 years old, but hung out with older teens most of the time, so nobody questioned her presence. At around 3 in the morning, a friend told me the following story: Silvia had wandered into a cabin and fallen asleep, drunk, tired, or both. She woke up to a 17-year-old boy she didn’t know having sex with her. Silvia reported that rather than fighting, she “let him finish”, and now she was running around laughing and drinking more beer.

The general response from Silvia’s friends, and others at the party, was that if it had been rape, she would have yelled, or fought, or something. We didn’t stop and think that she might have been terrified, disoriented, or too intoxicated to know what to do. It also sounded suspicious that she slept through the first part of it – who sleeps through that? And if she’d been raped, she wouldn’t be seemingly having a good time afterwards, right?

Nor did it occur to us that perhaps a better question than “Why didn’t she stop it?” was “Why would a 17-year-old young man think it’s okay to start having sex with a a 13-year-old girl who was unconscious at the time?” The adage “Boys will be boys, so girls must take care,” would have sounded old-fashioned to us, but it was pretty much the principle under which we were operating.

This was over 20 years ago. While I dearly hope that teens today know enough to think differently in a similar situation, I know from patient stories that this isn’t always the case.

This is the concluding post in this series. All of the posts have involved talking points with your teen, and I wanted to add (or reiterate) these:

  • When sexual assault occurs, the blame should rest on the perpetrator, not the victim.
  • Someone who is not awake, alert, and unimpaired cannot consent to sexual activity.
  • Sexual activity with someone much younger is not okay.
  • Consent should be a two-way communication, and you should always encourage your teen to speak up strongly against unwanted sexual advances. But in the end, it is the responsibility of the person initiating a sexual encounter to gain consent. It is not the responsibility of the person upon whom sex is being initiated to stop everything if they don’t like what’s happening.
  • Boys are not just going to “be boys” (how insulting is it to teen males to assume they are naturally going to sexually assault someone, given the chance?).  It’s not okay to accept that  ”girls should take care,” and let young women take on all the responsibility of preventing sexual assault.
  • While a young man sexually assaulting a young woman is the most common kind of sexual assault, women can sexually assault men, and same-sex sexual assault is all too common.
  • If you’re worried sexual assault is going to happen to a peer, tell them your concerns immediately and offer help. If you feel like the situation is out of control, seek help from a trusted adult right away.

Talk about these issues with your teen, and talk about them early. If every teen can have a firm grasp on these topics, the culture will change. Perhaps it wouldn’t have prevented Silvia’s sexual assault, but it might have meant that her friends, instead of reacting with ignorance and confusion, would have called out the perpetrator, offered Silvia help and support, or brought a trusted adult into the situation.

I am nowhere near organized enough to have planned this, but this last post went up the day that the Steubenville case from the first post in this series is going to trial.

The defense lawyers are arguing that the victim gave consent and “posed” for some of the incriminating pictures. The first witnesses have reported that she was so impaired she couldn’t walk.

I hope this series has brought up some interesting ideas for you and your teen to talk about. If there is something you wanted to see covered, but didn’t, please comment below! I can always add more posts or topics.

(Addendum: The perpetrators in the Steubenville case have been found guilty of sexual assault.)

* All names have been changed

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.


Why you may want to think twice about a health savings account

Photo by Brainloc

Photo by Brainloc

By Michelle Andrews

Health plan deductibles keep getting higher — the proportion of workers with a deductible that topped $1,000 for single coverage nearly tripled in the past five years, to 34 percent.

Since high-deductible plans often mean you pay more out of pocket for medical care, it might seem like a no-brainer to sign up for a plan that links to a health savings account so you can sock away money tax free to your medical expenses. But there are good reasons to think twice before making that choice.

In order to get the tax advantages of a health savings account, the health plan it’s linked to has to meet certain criteria. In 2013, for instance, an HSA-qualified plan has to have a deductible of at least $1,250 for single coverage and $2,500 for family coverage, and the maximum out-of-pocket limits can be no higher than $6,250 and $12,500, respectively, for single and family coverage.

But HSA-qualified plans have other limitations that consumers often aren’t aware of. For one thing, even though the Affordable Care Act allows parents to keep their adult children on their policies until they reach age 26, they can’t use funds from their HSA to pay for the child’s care after age 24.

In order to get the tax advantages of a health savings account, the health plan it’s linked to has to meet certain criteria.

That’s because “dependent” is defined differently for HSA purposes than it is under the ACA provisions that extend dependent coverage to adult children.

In addition, except for preventive care, which is generally covered at 100 percent and is not subject to the deductible, consumers in an HSA-qualified plan may be on the hook for the entire cost of medical care — including doctor visits, medications, tests and treatments — until they reach their deductible.

(They will be charged the negotiated rate their insurer has agreed to pay providers for services, however, not the “rack” rate paid by the uninsured.)

Regular high-deductible plans, on the other hand, offer many more options. In addition to covering preventive care at 100 percent, some function like traditional plans, requiring only a copayment for doctor visits and medicines even before the deductible is met.

Or they may offer a limited number of doctor visits with a copayment before people meet their deductible, says Carrie McLean, senior manager of customer care at, an online vendor.

Consumers need to evaluate the full spectrum of costs and benefits for HSA plans, but the advantages may have nothing to do with medical expenses, she advises. “The true benefit you get from these accounts is because you’re putting money away and you get that tax [savings],” says McLean.

Photo courtesy of Brainloc

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.


Snohomish emergency preparedness event seeks to engage diverse communities

Photo by Ada Be

Photo by Ada Be

Snohomish County will sponsor an emergency preparedness event next week that will focus on engaging the county’s diverse communities.

The EMPOWER emergency preparedness fair will seek to break down the barriers between emergency responders and minority communities through a day of presentations, information sharing, resource tables, and demonstrations, from 8 a.m. to 2 p.m., Sat., April 20 at Everett Station, 3201 Smith Ave., Everett.

The event is free and open to the public, and includes complimentary continental breakfast and lunch. Walk-ins are welcome or you can register at Brown Paper Tickets.

The day will have two educational tracks: One for community residents to learn more about being prepared for emergencies, and another for emergency responders to learn ways to respond more effectively to a diverse community.

“This fair is for people who want to learn more about getting prepared for earthquakes, storms, and other disasters,” said Therese Quinn, event organizer and Medical Reserve Corps coordinator. “It is also for emergency responders and planners who want to learn more about working with vulnerable populations.”

Morning presentations follow a welcome by Snohomish County Sheriff John Lovick.

The emergency responder track will hear a hands-on diversity panel discuss “What you need to know when you respond in my community.” Panelists will include individuals from the Iraqi and Latino communities, and lesbian, gay, bisexual, and transgender community.

The panel discussion will be followed by speaker Conrad Kuehn from the Northwest ADA Center, presenting “Disability Language and Etiquette.”

The community education track includes a presentation on how to prepare for an emergency and make an emergency kit. Following the kit demonstration, a panel will discuss the mission of emergency responders as public safety — and not immigration enforcement.

Panelists include Dave Alcorta, Red Cross; Sgt. Manny Garcia, Everett Police Department; and John Pennington, Snohomish County Department of Emergency Management.

The lunchtime keynote speaker will be National Fire Academy Instructor Leslie Olson, who will talk about the importance of cross-cultural communication.

All presentations and the lunch keynote speech will be interpreted into Spanish and translated by Communication Access Realtime Translation (CART) for the deaf and hard of hearing.

The event is the result of community partnership among Snohomish Health District, Tulalip Tribes, Fire District 1, Starbucks, Communities of Color Coalition, Snohomish County Emergency Management, Medical Reserve Corps, Puget Sound Energy, City of Everett, and South Everett

Photo courtesy Ada Be via Flickr


Consumer groups warn health plans could hit patients with large out-of-pocket costs

Photo by nyuszika

Photo by nyuszika

By Julie Appleby
KHN Staff Writer

Consumer groups are warning that insurers and employers may be able to keep offering health plans next year that include out-of-pocket caps for individuals of $12,500 or more — double the amount allowed under the federal health law.

The Obama administration has decided not to enforce that section of the law for some plans for another year, say 10 consumer groups which Monday wrote federal officials asking that the move be reconsidered.

“This is a very important consumer protection that is being undermined,” said Stephen Finan, policy director for the American Cancer Society Cancer Action Network, one of the groups that signed the protest letter. “Someone with a high drug bill could have out-of-pocket costs well in excess of the law.”

Under the federal law, starting Jan. 1 health plans must include certain benefits, such as hospital care and drug coverage, and must cap the amount consumers can be charged through deductibles, co-payments and co-insurance. That out-of-pocket cap next year is estimated to be about $6,250 for an individual.

But in a Feb. 20 FAQ put out by the Departments of Labor, Treasury and Health and Human Services, the administration noted that some insurance plans offered by employers have separate policies or benefit managers for different parts of their coverage, such as medical care and drugs, and sometimes a third for children’s dental services. Some employer plans have separate out-of-pocket caps for each of the coverage areas.

Because of the complexity, the FAQ gave insurers and employers another year to find ways to merge those caps. In theory, that means some plans next year may be able to double – or even triple – the $6,250 out-of-pocket cap, said the consumer groups. Plans with only one administrator overseeing all types of coverage are not exempted from the spending cap.

Finan said it is not known how many insurance plans offered by employers have multiple administrators, but it is thought to be fairly common.

He said administration officials indicated they allowed the one-year delay of the cap because “they got considerable feedback from health plans and employers that they could not comply or do the changes to develop a single out-of-pocket limit.”

Administration officials were not immediately available for comment.

The consumer groups say technology exists that could simply combine the separate administrative functions to create a single out-of-pocket cap, eliminating the need for the extension.

Failing that, the groups asked the federal officials to simply divide the total amount of the cop among the different administrators, so that consumers do not face higher limits than allowed under the law.

“The FAQ does not have the force of law, but what it simply says is the Department of Labor is not going to enforce the law,” said Finan, who added that the groups had been in talks with administration officials on the issue since February.

He said the groups were especially concerned after learning from the administration that some drug plans have no out-of-pocket maximums and will not be required to set one next year.

Other signatories of the letter sent to the Departments of Labor, Treasury and Health and Human Services include AARP, the American Heart Association and Consumers Union.

Photo courtesy of nyuszika

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.


Massachusetts moves to curb healthcare costs


Map of BostonBy Christine Vestal
Stateline Staff Writer

BOSTON—As other states continue to debate the merits of the Affordable Care Act or race to implement it, Massachusetts is moving on to the next big challenge: curbing health care costs.

Under a law signed by Democratic Gov. Deval Patrick last August, Massachusetts is putting its health care industry on an annual budget and requiring all of the state’s insurers and medical providers to make public the prices of the services they offer. Beginning on Oct. 1, consumers will be able to view price comparisons online.

Seven years after its groundbreaking health reforms, which became the model for the Affordable Care Act, Massachusetts boasts an uninsured rate of less than 2 percent, compared to a national average of 16 percent. But the cost of health care in the state, the highest in the country before the reform law was passed, remains so. Nationwide, health care costs per person are higher in the U.S. than in any other country in the world.

Without change, people in the Massachusetts health care industry say rising costs will unravel the state’s nearly universal health care coverage, bankrupt businesses and crush the state budget. Chapter 224, as the law is known, is projected to save $200 billion over the next 15 years.

There is no single cure for the nation’s health care cost problem, but most economists agree it is essential to arm consumers with detailed price lists and quality reports from hospitals, doctors and other health care providers so they can make informed choices about their care.

According to standard economic theories, health care providers would then respond to consumer pressure by offering cheaper, more competitive services. To do that, they would have to become more efficient at delivering care without jeopardizing quality.

“You cannot tell me that better care and lower costs don’t go together,” said Dr. Donald Berwick, former director of the Centers for Medicare and Medicaid Services. ”Better care costs less than worse care.”

The Massachusetts law also funnels money to community hospitals, wellness programs and health information systems, and calls on insurers to move away from traditional “fee-for-service” payment methods and instead reward providers for the health outcomes of their patients.

“I’m confident that just as we showed the nation how to deliver universal care, Massachusetts will be the place that cracks the code on cost containment,” Patrick told a conference of health care journalists in Boston last month.

Price Transparency


Highest Health Care Spending Per CapitaPublic and Private, 2009 (Or Nearest Year)
United States $7,960
Norway – $5,352
Switzerland – $5,144
Netherlands – $4,914
Luxembourg – $4,808
Canada – $4,363
Denmark – $4,348
Austria – $4,289
Germany – $4,218
France – $3,978

Although no other state has required the health care industry to publish its prices, 11 states have taken preliminary steps to shed light on the real cost of medical care. Colorado, Kansas, Maine, Maryland, Minnesota, New Hampshire, Oregon, Tennessee, Utah, Virginia and Vermont are in various stages of developing so-called “all payer claims databases” that collect and analyze the widely varying prices health care providers charge private insurers, Medicare, Medicaid, uninsured individuals and other payers. In all other states, these transactions are considered confidential business information and kept under wraps.

For some time, state officials have been using the state claims data, but it has only given them a retrospective look at the market.

The Massachusetts data that will be available in October will give consumers a current view of the prices their carriers pay for services.

That information, both price lists and quality reports, will come directly from insurance companies and providers.

Len Nichols, an economist at George Mason University, said the health care industry will never become a functioning market without this kind of detailed pricing information. In the meantime, though, “the industry is focused like a laser beam on the cost issue,” he said.

Some critics say the federal health law does not do enough to lower costs, but it includes provisions designed to limit the growth of Medicare payments to hospitals. For example, it financially penalizes hospitals for excessive readmissions of previously released patients, and ties providers’ price increases to the growth rate of the overall economy.

Under those restrictions alone, Nichols predicted, “the richest hospital in the country will hit bone in five years unless it makes major changes.”

Medicare, the $555 billion federal health care program that serves more than 50 million elderly and disabled people, pays for 28 percent of all hospital charges and 24 percent of physician charges, according to the Kaiser Family Foundation. The federal health law includes $716 billion in Medicare payment reductions over the next 10 years.

Despite Medicare’s clout, some expect states to play the primary role in reducing health care costs. Raymond Scheppach, former director of the National Governors Association, heads the State Health Care Cost Containment Commission at the University of Virginia. He believes states will assume responsibility for the cost of health care.

“The reason,” he says, “is that about one third of all Americans are going to get their coverage through Medicaid or the [health insurance] exchange.”

An Experiment

Critics cite one major problem with the Massachusetts law: It is unenforceable. If the industry exceeds the 3.6 percent annual growth limit this year, the state can levy penalties on providers, but they are widely considered too small to force health care companies to change.

Supporters of the law acknowledge it has no teeth, but insist it has concentrated attention on the problem. “The target is having a big impact on the health care industry here,” said David Cutler, a Harvard economist who advises the state. “It’s making people think about contracts that are being written and their expectations about the future.”

Insurers, so far, appear to be taking the target seriously, if for no other reason than to avoid a more punishing law in the future. Blue Cross of Massachusetts CEO Andrew Dreyfus said his organization is doing everything it can to slow cost growth so that an enforceable law – one that actually sets prices for the health care industry – won’t be needed.

One such Blue Cross initiative is a so-called “tiered” insurance policy that offers consumers a network of low-cost, high quality hospitals, but allows access to higher priced hospitals for a higher co-pay. “It’s our fastest growing product,” Dreyfus said.

Experts differ on whether Massachusetts is taking the right approach, but no other state has launched such a broad-based attack on rising health care costs, and the rest of the country is eagerly anticipating the results.

“Just as with our 2006 access law, other states will be watching and seeing how this experiment moves forward,” said David Seltz, health policy commissioner. “I feel certain we’ll have some positive results to show.”
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.

same sex wedding thumbnail

Same-sex spouses can face barriers on healthcare DOMA


same sex wedding 397By Michelle Andrews

Mike Bosia and Steven Obranovich, of Hardwick, Vt., were married three years ago after Vermont legalized same-sex marriage. As Bosia’s spouse, Obranovich is entitled to health insurance through Bosia’s employer, Saint Michael’s College in Colchester.

But that coverage comes at a cost.

The couple estimates that they have had to pay $4,500 in additional federal income tax and filing-related expenses because the federal government is prohibited by the Defense of Marriage Act (DOMA) from recognizing same-sex marriages.

Bosia, 51, has to pay that tax on the value of the health coverage he gets for Obranovich, 45.

Bosia says the difference in tax treatment at the state and federal levels creates headaches for the couple’s accountant at tax filing time.

Dealing with the different rules, he says, “takes more time and costs more.”

According to a report published by two think tanks, the Center for American Progress and the Williams Institute, which conducts research on gender identity and sexual orientation, an employee who buys health insurance for a domestic partner of the same or opposite sex pays $1,069 more a year in federal taxes, on average, than a worker in a heterosexual marriage would pay for the same coverage.

Nine states and the District of Columbia currently permit same-sex marriage, according to the National Conference of State Legislatures.

Last month, the Supreme Court heard oral arguments in two cases that relate to same sex marriage. In addition to the challenge to DOMA, the court considered a California-based case challenging whether states can ban same-sex marriages.

The rulings are unlikely to have a direct impact on same-sex couples in domestic partnerships or civil unions, says Tara Borelli, a staff attorney at Lambda Legal, an advocacy organization for lesbian, gay, bisexual and transgender people.

A decision by the court that DOMA is unconstitutional might eliminate significant barriers that same-sex married couples face related to health care and health insurance. The inequity in federal tax treatment is the most obvious hurdle, but it’s not the only one.

Federal laws that protect workers and their families from losing health insurance don’t apply to same-sex married couples. Under the federal law known as COBRA, for example, workers at many companies can hang on to their job-based health insurance for themselves and their families for up to 18 months in most cases. But the law doesn’t offer this guarantee to the same-sex spouses of former employees.

Likewise, under federal law employees can add a new spouse to a health plan immediately, and if your spouse loses group health coverage, he or she can generally switch to your plan without waiting for the annual enrollment period. These protections don’t apply to same-sex married couples.

The Family and Medical Leave Act allows eligible employees unpaid time off to care for a seriously ill family member, but it doesn’t apply to same-sex spouses.

Companies are increasingly providing benefits to same-sex couples, even if they’re not required to. Last year, 54 percent of employers with 10 or more workers offered same-sex health insurance benefits, up from 24 percent in 2008, according to Mercer, a human resources consulting firm.

“There’s certainly been remarkable progress among companies in viewing and treating their same-sex and opposite-sex partners the same,” says Deena Fidas, deputy director of corporate equality programs at the Human Rights Campaign, an advocacy group.

Privately insured couples aren’t the only ones who may run into difficulty with health insurance. Because of DOMA’s definition of marriage, federal employees can insure a spouse only if that partner is a member of the opposite sex.

Moreover, under Medicare, a non-working spouse may qualify for coverage upon reaching age 65 if the working spouse has been employed for at least 40 quarters, usually 10 years. But a non-working same-sex spouse can’t qualify on the basis of his or her partner’s work history, experts say.

A same-sex spouse may also face difficulties if he or she wants to delay signing up for Medicare after turning 65. The penalty for delaying enrollment may be waived for a married person who has coverage under a spouse’s employer-sponsored plan, but if the federal government doesn’t recognize the marriage, the penalty may apply.

“Anytime we run into the ‘spouse’ term, we run into problems for same-sex couples under DOMA,” says Brian Moulton, legal director at the Human Rights Campaign.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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.


Believe in your buds


vegetablesWe all had that one vegetable we refused to eat as a child, but times (and taste buds) change!

Don’t let the past prevent you from getting the nutritional benefits of asparagus, Lima beans, peas, Brussel sprouts, or your personal veggie villain.

Our flavor profiles vary greatly with age: you may just find a new favorite in your former foe.

Embrace your adulthood this week by trying a vegetable that you wouldn’t have touched as a child.

Start slowly by adding it to a favorite dish.

If it’s not love at first bite, congratulate yourself for giving it a try anyway.


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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Teens and Sexual Assault, Part 6: Sexual Assault Within A Relationship

Photo by Sanja Gjenero

Photo by Sanja Gjenero

This article first appeared on Seattle Children’s Teenology 101 blog.

When I was about 15, a friend was confiding in me about our friend Sasha’s* fight with her boyfriend James*. Sasha had been dating James for a while, and their relationship included sexual activity. She told me that Sasha had cheated on James, and he had found out and been furious.

“What did he do?” I asked.

“He was really mad. He yelled at her and threw things and made her have sex with him,” she said.

“Like, he made her have sex, when she was saying no?” I said, incredulous.

“Well… I don’t know. I don’t think so. He said she was crying but didn’t fight him or anything.”

Reading this as an adult makes me cringe. But as teens, we were a little confused as to whether James could really rape Sasha, given that they were going out and had had sex before.

When we saw Sasha next, she and James were together and they seemed happy. We concluded that she couldn’t have been sexually assaulted.

When we think of teens being sexually assaulted, we often think of stranger/ acquaintance rape, but teens can and are sexually assaulted by their romantic partners. This can occur even if they have consented to sex in the past, and might again in the future. Consenting to one episode of sexual contact does not mean that there is blanket consent for sexual consent at all times.

This seems like an easy concept for adults to understand, but it’s important to remember that the very idea of date and marital rape wasn’t really addressed by our society until the 1970s. One of my earliest memories of talk radio is listening to (and being confused by) a debate in the early 80s that boiled down to, “Is it really possible to rape your own wife?”

Teens- especially younger teens- can be confused by the concept of sexual assault within the confines of a romantic relationship that has already involved sexual contact. It’s important that teens realize that it’s wrong to make, or coerce, someone into having sex, even if they’ve consented to sex before.

It’s also important that teens know they can say no to someone- with every expectation of an immediate halt to sexual activity- even if they’ve said yes before, no matter what the circumstances. In Sasha’s case, I found out later she felt she’d “deserved it” for having sexual contact with someone else while dating James.

While it’s very important that your teen realize that it’s important to gain consent for sexual contact, they also need to know that consent is important for every sexual contact.

It doesn’t necessarily mean that a teen has to seriously sit down and formally ask for consent every time (although they can if they want to), but they do need to realize that consent is not a one-time process when one is dating someone, or has had sexual contact with them before.

This may not be one of those concepts where you can give a step-by-step guide on how to deal with it, but it’s still important that they’re aware the concept exists.

Once you’ve discussed how important this is with your teen, ask them how they’d go about making sure every sexual contact is consensual. There isn’t one correct answer. Discuss their ideas with them.

Depending on your teen, they may be so embarrassed at the idea of talking to you about this that they stop the conversation, which is fine. Once you’ve asked the question, you can leave their mind to fill in the blanks when it’s time… although bringing it up again when they’re in a romantic/ sexual relationship never hurts.

What conversations have you had with your teen about this? What was their reaction?

*Names changed

Top photo courtesy of Sanja Gienero

About Jen Brown, RN, BSN

Jen Brown, RN, BSN Teens never cease to amaze me with their strength, creativity, and new perspectives! Throughout my career, I’ve enjoyed helping teens and their parents tackle health concerns and navigate social issues. Nursing is my second career; my first degree was in biology from Carleton College, and a few years later I went to the University of Virginia for their Second Degree Nursing Program. Recently I began a graduate program at the University of Washington.

Potential volunteer Renette Johnson high fives Scott Atnip, congregational outreach director at Texas Impact, following a volunteer training program in Huntsville, Texas (Aaron M. Sprecher/AP Images for Kaiser Health News).

Health care law’s big task: explaining it to consumers

Potential volunteer Renette Johnson high fives Scott Atnip, congregational outreach director at Texas Impact, following a volunteer training program in Huntsville, Texas (Aaron M. Sprecher/AP Images for Kaiser Health News).

Potential volunteer Renette Johnson high fives Scott Atnip, congregational outreach director at Texas Impact, following a volunteer training program in Huntsville, Texas (Aaron M. Sprecher/AP Images for Kaiser Health News).

By Jenny Gold

KHN Staff Writer

This KHN story was produced in collaboration with 

When President Lyndon B. Johnson wanted to enroll seniors for the new Medicare program he had just signed into law, the story goes that his administration sent out workers on dog sleds to reach people in the remote Alaskan tundra.

“The Forest Service even had rangers looking for hermits in the woods,” recalled the late Robert Ball, Johnson’s Social Security commissioner, in a documentary on Medicare’s 40th anniversary.

Potential volunteer Renette Johnson high fives Scott Atnip, congregational outreach director at Texas Impact, following a volunteer training program in Huntsville, Texas (Aaron M. Sprecher/AP Images for Kaiser Health News).

The plan to insure as many as 27 million Americans under the federal health law beginning this fall will be the biggest expansion of health coverage since that launch. Millions will be eligible to shop for insurance in the new online marketplaces, which open for enrollment Oct. 1 with the coverage taking effect Jan. 1.

<p”>But six months before the process begins, questions are mounting about the scope and adequacy of efforts to reach out to consumers – especially in the 33 states that defaulted to the federal government to run their marketplaces, also called exchanges. The Obama administration has said little about outreach plans for those states, and neither the money nor the strategy is apparent.

“I’m getting very worried,” says Stan Dorn, a senior fellow at the nonpartisan Urban Institute, who studies outreach and enrollment for health programs. “Most health coverage expansions have not reached their target populations very quickly.”

‘A Pittance’

Ron Pollack, executive director of the advocacy group Families USA, and an administration ally, says he is hearing that as little as $40 million to $50 million in federal grants may be available to hire nonprofit groups to work directly with consumers in the states with federally-run marketplaces – a number the administration declined to confirm.

“That’s a pittance compared to what’s needed to make the application process work,” Pollack says. “It doesn’t even scratch the surface” — even in tandem with privately funded efforts.

That pot of money will cover grants to hire people to help consumers in 33 states with federally-run exchanges, including Texas and Florida, which have some of the nation’s highest uninsured rates. Just for comparison, California has budgeted more than $50 million for ‘in person’ help for consumers this year and next, and another $200 million for outreach and education.

Officials at The Centers for Medicare & Medicaid Services declined requests to discuss their outreach budget or strategy in the marketplaces run by the federal government. In a written statement, the agency says it is “coordinating with federal agencies, states and external partners to educate consumers and motivate them to enroll.”

Enrolling people under a law that few know anything about was always going to be challenging. Three years after the law’s passage, polls show widespread ignorance about its provisions.

“It’s not hard to get sick people to sign up for health insurance,” says Bob Laszewski, a Virginia-based consultant and former insurance executive. “But it’s really hard to get healthy people to sign up. If we don’t get a healthy cross-section, the financial structure of the [Affordable Care Act] unravels,” and premiums will skyrocket.

‘Ready, Set, Go?’

Resource disparities between states heighten the challenges. The law’s framers gave states broad financial assistance to set up their online marketplaces. They also required the federal government to set up the exchanges if states failed to do so but didn’t create a separate pot of money for that effort. The assumption was that most states would step up.

Texas Impact's Scott Atnip talks about the community group's plans to help the uninsured sign up for coverage (Aaron M. Sprecher/AP Images for Kaiser Health News).

Texas Impact’s Scott Atnip talks about the community group’s plans to help the uninsured sign up for coverage (Aaron M. Sprecher/AP Images for Kaiser Health News).

In the end, however, only 17 states and the District of Columbia did. Resources for the federal effort may also be constrained because of the spending cuts imposed by budget sequestration.

Private foundations, health industry groups and advocacy groups on the state and national level say they are determined to fill the gaps in states like Texas and Florida, but how successful they’ll be remains to be seen.

“I feel like we need a ready, set, go,” from the federal government, says Bee Moorhead, executive director of Texas Impact, a faith-based group, who is hoping that federal grants to pay nonprofit groups for help will be announced soon.

“In Texas, people have been tapping their toes and drumming their fingers,” she says. “We know we have a big uninsured population, we know we have a strong faith-based community working hand-in-hand with the state, and we know we have the ability to get things done. We need someone to say, ‘It’s time. Let’s do it.'”

Blue Cross Blue Shield of Texas also recently launched “Be Covered Texas,” an initiative undertaken with community-based organizations including churches, school programs and clinics, to educate consumers.

Enroll America, an offshoot of Families USA staffed with tech-savvy former campaigners for President Obama, is also hoping to step up to fill the gaps. The group has 13 staffers now, but hopes to ramp up to as many as 300 deployed in states with high uninsured rates and scarce resources, says President Anne Filipic, a former White House official.

The group, which is raising money from the health care industry, among other sources, expects to begin reaching out to consumers in late spring or early summer. It’s relying on the sort of social media campaign that was key to Obama’s 2012 reelection, Filipic says.

From left to right Rebecca Leggett, Rev. Dave Smith and Scott Atnip discuss outreach plans (Aaron M. Sprecher/AP Images for Kaiser Health News).

The campaign was about getting votes; now the trick is “how do you use [those techniques] to compel people to sign up for health insurance,” she says.

Still Time For Consumers To Plan

With six months to go, there’s also still time for the president to “use the megaphone,” says Dan Mendelson, CEO of consulting firm Avalere Health and a former Clinton administration official.

When Mendelson worked on outreach for the Children’s Health Insurance Program in the 1990s, “we had Bill and Hillary Clinton and Al and Tipper Gore all going state to state. I attribute our success to that.”

So far, however, Mendelson says the administration has not focused on reminding the public that purchasing health insurance will soon be “an obligation that everyone has,” whether they like it or not.

That obligation takes advance planning for families with little disposable income. “If people need to pony up $5,000, they need time to prepare for that,” he says.

And that means telling them the time is coming soon.

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.


Despite fears of ‘sticker shock,’ young adults should have reasonable plan options on exchange


Twenty-dollar bill in a pill bottleBy Michelle Andrews

As landmark dates approach in the health-care overhaul, readers are trying to figure out how the new insurance exchanges will work. Here are some recent questions:

Q. After the exchanges go live in 2014, will consumers still be able to buy individual health insurance directly from carriers, without going through those state-based marketplaces? I fear the rules of the plans operating within the exchange will make the premiums unnecessarily high for younger, healthy people.

A. Consumers will be able to buy individual health insurance next year either through the state insurance exchanges or on the private market. Regardless of where they buy a plan, however, all new individual policies will have to meet certain standards related to coverage and cost.

Under the law, premiums for older people cannot be more than three times higher than those for younger ones. Currently, the gap between how much younger, typically healthier people pay for coverage and how much older people pay is larger than that, leading some experts to predict that younger people’s rates will skyrocket next year.

An analysis published last month by the Urban Institute suggests that will not happen. Although premiums will be higher for many young people under the new rules, this increase will have very little impact on their out-of-pocket costs, the study found.

The reason: The vast majority of young people will be eligible for subsidized coverage — through the exchanges, Medicaid or their parents’ health plans. On the health insurance exchanges, premium subsidies will be available to people with incomes up to 400 percent of the federal poverty level — $45,960 for an individual in 2013.

“If you’re young, you do want to go on the exchanges because you’ll qualify for subsidies,” says Jen Mishory of Young Invincibles, an advocacy group.

In addition to enrolling in regular plans, people up to age 30 will have the option of using the exchanges to buy less expensive, high-deductible policies that protect primarily against catastrophic events.

Although these policies might require large out-of-pocket payments by members — the deductible probably will be more than $6,000, for starters — they will be required to cover preventive care without any co-pay or cost sharing, and three primary-care visits will be covered even if the deductible has not been met.

Q. If employers stop providing coverage and employees have to purchase individual policies on or off the exchanges, do the employees lose the option to make pre-tax contributions to their health savings accounts?

A. You’ll be able to make pre-tax contributions as long as you buy a policy that meets federal standards for plans that can be linked to health savings accounts.

This means a high-deductible policy. In 2013, HSA-qualified plans must have a deductible of at least $1,250 for individual coverage and $2,500 for a family plan, among other requirements.

The amount that individuals and their employers can contribute to the accounts is limited to $3,250 and $6,450 for individual and family coverage, respectively. (The Internal Revenue Service makes cost-of-living adjustments to these and other limits annually.) Even if your employer no longer offers health insurance in 2014, any money in the HSA is yours to use for medical expenses.

Some of the policies offered on the exchanges may qualify as HSA plans, says Carrie McLean of, an online vendor. But it’s too soon to know whether carriers will offer such plans or the exchanges will choose to carry them, she says.

Q. In 2014, can someone who works for a company drop his coverage and buy it through a state exchange instead?

A. Next year, most people will be able to choose to buy a health plan on the exchange. As I said above, individuals whose income is less than 400 percent of the federal poverty level may be eligible for a subsidy. This can make buying a policy on the exchange an attractive option.

But even if you meet the income requirements, you won’t be eligible for a subsidized exchange plan unless your job-based coverage is considered unaffordable (because premiums for individual coverage cost more than 9.5 percent of the individual’s income) or inadequate (because the plan covers less than 60 percent of allowed medical expenses).

Q. What’s to stop people from just paying the individual mandate penalty and buying coverage when they need it, since insurers won’t be able to turn them down because of a preexisting condition?

A. If you decide to drop coverage altogether, the penalty for not having insurance in 2014 will be either $95 or 1 percent of your taxable income, whichever is greater.

To discourage people from waiting to buy insurance until they’re sick, there will be an open enrollment period for buying coverage on the exchanges from October 2013 through March 2014.

If you don’t sign up during that time and you subsequently get sick, you won’t be able to sign up until the following year in most cases.

This article was produced by Kaiser Health News with support from The SCAN Foundation.

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.


Health headlines from the Seattle Times

Seattle Times News Partner
Sunday, April 7, 2013

One healthful thing we love
Living Naturally: Be Your Own Boot Camp, April 7 (Sun, 4/07)

The People’s Pharmacy
Pickles: the cracked-mouth cure
(Sun, 4/07)

Tackle your body’s trouble spots to prep for summer
Get your tummy, hips and upper arms in shape for some warm weather exposure. (Sun, 4/07)

‘At fertilization’ declaration gives some pause
Advocates on both sides of the abortion issue acknowledge that the wording in the new Kansas measure could prove helpful to abortion opponents over time. (Sat, 4/06)

China reports 2 more cases of new bird flu virus 
Shanghai has reported two more cases of human infection of a new strain of bird flu, raising the number of cases in eastern China to 18. Six of the people who contracted the virus have died. (Sat, 4/06)

Pork found in Ikea’s moose lasagna 
Ikea says it has withdrawn 17,000 portions of moose lasagna from its home furnishings stores in Europe after traces of pork were found in a batch tested in Belgium. (Sat, 4/06)

Obama faces choice on morning-after pill limits 
President Barack Obama supports requiring girls younger than 17 to see a doctor before buying the morning-after pill. But fighting that battle in court comes with its own set of risks. (Sat, 4/06)

Fit For Life
That’s the team spirit: Group sports are great for motivation
Consider joining a sports league with a bunch of other adults who want to resuscitate skills from childhood or are interested in learning a new sport. (Fri, 4/05)

China steps up response to deadly avian-flu outbreak
China’s H7N9 influenza outbreak is testing a government known for its lack of transparency and reluctance to divulge damaging news. (Fri, 4/05)

Kansas lawmakers OK anti-abortion bill that says life begins ‘at fertilization’
Abortion opponents call the “at fertilization” a statement of principle and not an outright ban on terminating pregnancies.(Fri, 4/05)

Morning-after pill restrictions for young teens overruled by federal judge
A federal judge in New York offered a scathing rebuke of the 2011 decision by Health and Human Services Secretary Kathleen Sebelius to bar over-the-counter sales of the morning-after pill to girls younger than 17. (Fri, 4/05)

Fit & Fun
Fit & Fun: Take a bow — and give archery a go 
There are several places not too far from Seattle to check out the sport of archery. (Thu, 4/04)

New bird-flu death reported; Chinese slaughter poultry
Health officials in China believe people are contracting the new bird-flu virus through direct contact with infected fowl and say there has been no evidence that the virus is spreading easily between people. (Thu, 4/04)

Walgreen clinics expand care into chronic illness 
Walgreen Co. has stretched the reach of its drugstore clinics beyond treating ankle sprains and sinus infections to handling chronic diseases such as diabetes, asthma and high blood pressure. (Thu, 4/04)

Michelle Obama challenges kids with lunch contest 
Children from across the nation will rub elbows with Michelle Obama and dine off fine china in the East Room of the White House this summer as part of a contest to promote healthy eating. (Wed, 4/03)

Dementia-care costs top spending on cancer, heart disease
The most rigorous study to date of how much it costs to care for Americans with dementia found that the financial burden is at least as high as that for either heart disease or cancer, and is probably higher. (Wed, 4/03)

Many young women live with men first, marry later 
Nearly half of young women say the first time they lived with a guy, they weren’t married. (Wed, 4/03)

FDA says longer use of nicotine gum is OK 
The Food and Drug Administration says smokers who are trying to quit can safely use over-the counter nicotine gum, patches and lozenges for longer than previously recommended in a move to help millions of Americans kick the habit. (Mon, 4/01)

Swedish CEO moves to 5-hospital Atlanta group
Swedish Medical Center’s CEO for the past year is leaving to lead a hospital system in Atlanta. Marcel Loh has been named interim chief executive. (Mon, 4/01)

FDA approves new drug to treat type 2 diabetes
Invokana uses new a method to lower blood sugar in people with Type 2 diabetes: It flushes it out in patients’ urine after the kidneys filter it from the blood. (Sun, 3/31


E. coli outbreak leads to expanded recall of frozen food products


Alert Icon with Exclamation Point!The Washington State Department of Health is warning people that several types of frozen food products – Farm Rich, Market Day, and Schwan’s brands – have been recalled due to possible contamination with E. coli.


The products were distributed widely throughout Washington.

The recalls are related to a national E. coli outbreak that sickened 27 people from 15 states, including a Pierce County woman in her 20s.

“The foods in this recall were sent to stores throughout our state,” said Dave Gifford, Food Safety program manager. “E. coli can be very serious. We’re asking people to look at the recall list, check their freezers carefully, and throw out any of these products that they find.”

The type of E. coli in this outbreak is a strain of Shiga toxin-producing E. coli O121 (STEC O121), which is similar to E. coli O157:H7.

It can cause diarrhea, abdominal cramps, bloody diarrhea, fever, and vomiting. It can sometimes result in severe, life-threatening illness.

The recalled product list continues to expand and now includes several varieties of frozen snacks and mini-meal products.

The full list of the products currently covered by the recall is on the U.S. Department of Agriculture’s website; more info is on the Food Safety Program website.