Wordle

Some policies restrict coverage by limiting doctor visits

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By Consumer Columnist Michelle Andrews

When examining your health benefits for the new year, you’ll probably notice that your plan has eliminated lifetime and most annual dollar limits on coverage.That was mandated by the federal health-care overhaul.

But for some consumers, coverage may still be restricted: Limits on the number of doctor visits or prescriptions or other services continue to be permitted and can stymie patients’ efforts to get necessary care.

Take Rene Bane. A 50-year-old sign-language interpreter who lives in Bowie, Bane needs surgery to prevent her shoulder blade from rubbing against one of the tendons in her shoulder. Left untreated, the rubbing might cause the tendon to snap, her doctor says. Meanwhile, the inflammation is very painful.

Bane would need thrice-weekly physical therapy sessions for at least three months following surgery. But while the insurance that she has through her husband’s job doesn’t place a dollar cap on physical therapy benefits, it covers only 20 such visits a year.

“This seems like a terrible loophole,” she says. “Removing those dollar limits just means they’ll put on limits in a different way.”

Bane has decided not to get the surgery, at least for now.

So far, most companies don’t seem to be adding new numerical limits on services to compensate for the elimination of lifetime and annual benefits, says Mike Thompson, a human resource services principal with benefits consultants PwC.

But “it could potentially be a bigger problem moving forward,” says Stephen Finan, senior director for policy at the American Cancer Society’s Cancer Action Network.

The health law requires that plans sold on the state-based insurance exchanges that will start up in 2014 cover certain “essential health benefits,” including hospitalization, prescription drugs and rehabilitative care, such as physical therapy.

The secretary of Health and Human Services is charged with defining exactly what the coverage will be for these essential benefits, but those details aren’t expected until next year. (Implementation of the health-care overhaul is moving forward despite court challenges.)

Some policy experts say they hope that the coverage requirements will steer clear of arbitrary numerical limits and instead emphasize evidence-based research on the most cost-effective treatments.

That approach would permit physical therapy to the extent that it was medically necessary, no more and no less. Using blunter instruments such as deductibles or limitations on visits risks “discouraging both effective and ineffective care,” says Edwin Park, co-director of health policy at the Center on Budget and Policy Priorities.

Whatever HHS decides about “essential” coverage will only be required of plans sold on the state-based exchanges, primarily to individuals and companies with fewer than 100 workers, and of small-group and individual policies sold on the private market.

It won’t affect millions of people who get their health insurance on the job through big companies. But since large employers tend to offer more-generous health insurance benefits than small ones, they may already meet the new standards once they’re set, say experts. Those that don’t may find it prudent to move in that direction.

“For better or for worse, that [benefits package] will have the imprimatur of the federal government,” says Finan.

The new benefit standards could help KayAnn Schuck of Pinckney, Mich. Laid off from her job as a medical technologist, Schuck received a diagnosis of breast cancer in May 2009. She had signed up for COBRA coverage through her former employer when she was laid off, and that carried her through her initial treatment.

But her COBRA ran out at the end of last May, and she signed up for an individual policy with a $254 monthly premium.

More From This Series: Insuring Your Health

Schuck, 48, has regular appointments with a radiation oncologist, breast surgeon and other specialists to manage her treatment.

She underwent breast reconstruction surgery over the summer. After her surgery, she couldn’t understand why she was getting billed for doctor visits.

Then she learned that her policy pays for only two visits to a doctor’s office annually. She estimates she owes $11,000 to various providers. She is slowly paying down the debt.

“I’ve been in tears more times than I can count,” she says. “I just don’t understand the logic of these insurance limits.”

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

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Sleep

How to stay rested through the holidays

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A hectic holiday schedule can run anyone ragged — but lack of sleep can make things worse, warns Dr. Sarah Stolz, medical director of the Sleep Center at Seattle’s Northwest Hospital and Medical Center, part of UW Medicine.

“Around the holidays, most people don’t get enough sleep. They have Christmas chores to do, events to attend, visitors to entertain. Getting enough sleep goes way down the list of priorities,” Dr. Stolz says.

But even with all the holiday stress and turmoil there are a number of simple steps you can take to protect your sleep and make your holidays as relaxed and enjoyable as possible, says Dr. Stolz.

First, try to stick your regular sleeping schedule as much as possible, Dr. Stolz suggests. That may be hard to do, she admits, especially when you want to stay up late to welcome in the New Year’s, but if you stay up late, try to get back your regular schedule as quickly as you can.

“Sleeping in occasionally isn’t usually a big problem,” says Dr. Stolz, “but you want to avoid doing it regularly.”

“Taking a short–15 to 30 minute–nap can also be very helpful,” she adds, “but it is best to avoid naps later in the day, say after 3 or 4 p.m.”

Children, especially adolescents, tend to stay up later and later over vacations sleeping in longer and longer in the morning.

This can throw them off during the day and make it hard for them to get back into their regular schedule when it’s time to go back to school.

So try to help your children stick as closely as possible to their regular sleep schedule, Dr. Stolz recommends, or at least try to ease them back to their regular schedule as the end of vacation nears.

At those holiday feasts, try to avoid eating a lot late in the evening, she says. Contrary to what many believe, a heavy meal won’t necessarily help you sleep and may actually keep you up, and avoid drinking alcohol late in the evening, Dr. Stolz warns.

Dr. Sarah Stolz

Dr. Sarah Stolz

“Because people often feel drowsy when they drink, they think it helps them get to sleep. But that sedative effect is short-lived, and as it wears off, the alcohol can in fact act as a stimulant. Many people wake up and can’t get back to sleep,” Dr. Stolz says.

In fact, that nightcap before bedtime can actually trigger some common sleep problems, such as sleep apnea, a serious breathing problem that cause your breathing to become shallow and even pause during sleep, Dr. Stolz says. Sleep apnea is a common cause of daytime drowsiness and untreated can lead to high blood pressure, heart disease and other serious conditions.

“If you’re a person who doesn’t snore and you drink, you might snore; it you’re a person who snores and you drink; you might have apnea; and if you’re a person with apnea, you might have worse apnea with more apneic spells and lower blood oxygen levels.” For that reason, Dr. Stolz and her colleagues recommend their patients with apnea not to drink in the last three or four hours of the day.

And that’s not a bad rule for everyone, says Dr. Stolz. “Try to drink in moderation and don’t drink late at night. If you are going to drink alcohol, have it early in the evening then switch to bottled water or some other non-alcoholic drink,” she said.  That will make your drive home safer as well, she adds.

To learn more:

  • Read the Good Sleep Hygiene Tips below.
  • Visit the Northwest Hospital & Medical Center’s Sleep Center website.
  • Read more sleep and sleep disorders on the National Library of Medicine’s MedlinePlus.

Good Sleep Hygiene Tips

  • Avoid caffeine within four to six hours of bedtime.
  • Avoid the use of nicotine close to bedtime or during the night.
  • Do not drink alcoholic beverages within four to six hours of bedtime.
  • While a light snack before bedtime can help promote sound sleep, avoid large meals.
  • Exercise regularly. Avoid strenuous exercise within 6 hours of bed time.
  • Try to sleep when you are drowsy.
  • If you are unable to fall asleep or stay asleep, leave your bedroom and engage in a quiet activity elsewhere. Do not permit yourself to fall asleep outside the bedroom. Return to bed when and only when you are sleepy. Repeat this process as often as necessary throughout the night.
  • Maintain a regular arise time, even on days off work and on weekends.
  • Avoid napping during the daytime. If daytime sleepiness becomes overwhelming, limit naptime to a single nap of less than 1 hour, no later than 3 p.m.
  • Establish a bedtime ritual.
  • Set aside time for worry and relaxation before going to bed.

______________________________

Dr. Stolz earned her medical degree from Case Western Reserve University in Cleveland, Ohio. She completed her neurology residency at the University of Massachusetts Medical Center in Worcester, followed by a fellowship in sleep medicine from the University of Michigan Medical Center in Ann Arbor, and her EEG training at the University of Washington in Seattle. Dr. Stolz is a sleep disorders medicine lecturer and clinical researcher and serves as clinical assistant professor for the Department of Neurology at the University of Washington Medical Center. Dr. Stolz has practiced sleep disorders medicine since 1991. Her personal Interests include bicycling, hiking, cross-country skiing, reading, music and spending time with her teenagers.

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Pregnancy

Flu shot protects mom and baby

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By Peter Luyckx
Contributing Writer

Women who are vaccinated against influenza during pregnancy pass along the vaccine’s protection to their baby for up to six months, according to recent study.

This is welcome news because children under six months old are most at risk from influenza (the flu), but they can’t get vaccinated because their immune system is too immature.

“When the mom is immunized against influenza, she creates antibodies against three different types of influenza that will protect her, but also cross the placenta and allow the baby to share some of those antibodies,” explains Dr. Jeff Duchin, chief of Public Health – Seattle and King County’s Communicable Disease Epidemiology & Section.

Infants born to mothers who had received a vaccine had a 41 percent reduced risk of laboratory-confirmed infection, the study found, and a 39 percent reduced risk of hospitalization compared to infants born to mothers who weren’t immunized.

The study, which was conducted on the Navajo and White Mountain Apache Indian reservations, was published online by the Archives of Pediatrics & Adolescent Medicine in Octorber. Angelia A. Eick, PhD of the Center for American Indian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland was the lead author.

The results aren’t all that surprising, says Dr. Kathleen Neuzil, director of the Influenza Vaccine Project at Seattle’s global health organization PATH who wrote an editorial commenting on the study with Dr. Justin Ortiz of the Division of Pulmonary and Critical Care at University of Washington Medical Center.

“We’ve known for a very long time that very young babies are protected against disease because [in utero] they get antibodies from their mothers. For example, babies don’t get measles at one month of age, because they’re protected through maternal antibody. That’s why we can wait to give the measles vaccine later in life to a child, when the antibody wanes.”

In the case of the flu, too, transferred antibody levels are highest in the first months after birth. In the study, infants of moms who received the vaccine had increased influenza antibodies in their blood up to three months of age. After three months of age, antibodies level dropped and by six months were no greater than those seen in the infants of unvaccinated mothers.

3-D model of the flu virus Credit: Dan Higgins/CDC

While the researchers mostly studied women vaccinated during the second or third trimester of pregnancy, women who get vaccinated in the first trimester would still pass on protection to their child, says Dr. Neuzil. “Antibodies don’t really start crossing the placenta until 20 weeks of gestation. But if the mother gets vaccinated in the first trimester, she still will have the antibody to pass on when the baby is developed enough.”

If the mother didn’t get vaccinated, but got the flu during pregnancy, she would also pass on antibodies to her child, but then the mother would also get sick, which could cause serious problems for both her and her baby, Dr. Neuzil adds.

Breastfeeding is another way that antibodies can get transferred from mother to child, but doesn’t provide additional protection, the study found.

If the mom didn’t receive a vaccine during pregnancy and wasn’t exposed to the flu, “the baby would be very susceptible,” warns Dr. Duchin. “Babies have extremely high rates of hospitalization and serious illness.”

In that case, the best strategy to protect the baby is to reduce the baby’s chance of being exposed to the flu.

“By immunizing the mom, the dad, and other family members, as well as caretakers who’d be in close contact with the baby, you decrease the likelihood the baby would come in contact with someone who could spread influenza to the infant,” Duchin says.

If the mom gets vaccinated after giving birth and she breastfeeds, she would transfer some antibodies to the infant, but nowhere near the same level as when the mom gets vaccinated during pregnancy, Duchin adds. “There’s no evidence of that level of antibody protection through breastfeeding being transmitted. Antibodies transfer through breastfeeding has been associated with protection mostly against gastro-intestinal infections, like diarrhea.”


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Good for mom too

This year’s flu vaccine covers three strains of the virus including the H1N1 “swine” flu, which first appeared in 2009 and quickly spread around the world. Pregnant women appear to be particularly vulnerable to this virus. During the recent H1N1 outbreak, although pregnant women make up only 1 percent of the population at any given time, they comprised about 6 percent of confirmed H1N1 deaths in the U.S., according to the Centers for Disease Control and Prevention (CDC).

While severe, the H1N1 pandemic, Dr. Duchin notes, wasn’t all that different from a regular flu season.

“Pregnant women suffer disproportionally every year,” says Duchin. “They have a higher rate of hospitalization and intensive care hospitalization than non-pregnant women.”

It’s not fully understood why pregnancy compounds the impact of influenza. Several factors are likely at play, including changes in the immune system that keep the mother’s immune system from attacking the fetus, which the immune system would ordinarily see as a foreign body.

Despite the increased risk, most pregnant women fail to get vaccinated against influenza. Only about one in ten pregnant women received a flu shot in 2008-2009, according to the CDC.

“The flu is underappreciated,” says Dr. Duchin. “If I told you that there was a mysterious new virus that was going to come into our community this year, kill about 20,000 Americans, cause hundreds of thousands of hospitalizations, cause many children to get sick and maybe a hundred were going to die, people would be very scared. That’s much worse than what we saw during SARS, but that’s what happens every year with influenza. People take it for granted and don’t take it very seriously, because it’s not novel and it happens every year.”

Increased awareness and extensive public health campaigns helped increase vaccination rates among pregnant women in 2009-2010. Data from ten states, including Washington, show that last flu season just over half of pregnant women received a seasonal vaccine, and more than 46 percent got an H1N1 vaccine, according to a CDC report, published on December 3.

Many women are concerned that a vaccine will hurt the fetus. They are particularly concerned about vaccines containing thimerosal, a mercury-containing compound. Although thimerosal is considered safe, Washington State law requires that pregnant women and kids under age three be given vaccines that are mercury-free (or thimerosal-free).

This year’s influenza vaccine protects against three strains of viruses, including H1N1. “Because there are three types that are circulating, even if you think you’ve had the flu, you still want to protect yourself against others,” says Dr. Duchin.

So far, flu activity in Washiongton State remains low, so now is a great time to get a shot, says Dr. Neuzil, and she urges pregnant women to get vaccinated.

“You’re doing it for yourself, but you’re also doing it for your baby.”

Peter Luyckx is a contributing writer to Seattle Local Health Guide and to Flip the Media. He is a graduate student in the Master of Communication in Digital Media program at the University of Washington and can be followed on Twitter @peterlux.

To learn more:

  • Visit the Washington State Department of Health’s Flu News webpage.
  • For information about influenza, where to get a flu vaccine, and costs, please visit Public Health -Seattle & King County’s flu season web pages.
  • For more general information and educational materials about preventing the spread of infections, visit Public Health’s Stop Germs, Stay Healthy! webpage.

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U.S. Constitution

Analysis: The long road to a Supreme Court decision on health law’s mandate

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The HCLSC – health care litigation spin cycle – is in overdrive now that a Reagan-appointed federal judge has strongly signaled in court that he is very likely to follow a George W. Bush appointee who struck down the individual mandate at the heart of the new health care law.

Republican critics of the law were saying that “several” (that is, two) judges had found unconstitutional the requirement that Americans obtain insurance or pay penalties.

Meanwhile, President Obama was saying: “We’ve got 12 federal courts who have dismissed similar lawsuits. So the majority of courts who looked at this issue so far are absolutely convinced that the health care bill is [constitutional].”

Twelve! Sounds convincing. But Obama neglected to note that 10 of those lawsuits were mostly beside the point because they were not aimed at the individual mandate or were dismissed on grounds that did not uphold its constitutionality.

If counting judicial noses at this early stage were a reliable guide to the likely fate of the health care law on appeal, the score would stand at two Clinton-appointed judges, George Steeh and Norman Moon, upholding the individual mandate; Bush-appointed Henry Hudson striking it down Dec. 13, and Reagan-appointed Roger Vinson sounding during an oral argument on Dec. 16 like he would do the same. The four sit in Detroit; Lynchburg and Richmond, Va., and Tallahassee, Fla., respectively.

But district judges’ rulings tell us little or nothing about what the federal appeals courts and the Supreme Court will ultimately do with these cases. Below is an overview of the litigation, what it’s about, and how it’s likely to unfold.
How many health care lawsuits are there? More than 20 have been filed around the country, some going to the heart of the law and some peripheral.

Why is one provision of the massive law getting so much attention?

First, it’s widely seen as a lynchpin of the Democrats’ goal — that just about every American have affordable insurance regardless of their health.

Without the mandate, many people might go without insurance – thus driving up premiums for everyone else – because they would know that whenever they need coverage they could easily get it.

Second, as a constitutional matter, the mandate is the law’s most vulnerable major provision because it is the first ever to require millions of Americans, in the name of regulating interstate commerce, to buy a commercial product that they  may not want to pay for.

Since the New Deal, the Supreme Court has allowed Congress extremely broad powers to regulate commerce.

But the Court has never said that that power is unlimited and has left room for questions such as one that Vinson asked: Could Congress “mandate that everybody has to buy a certain amount of broccoli?”

But if it’s necessary to pay for near universal coverage, it must be constitutional, right?

The Obama administration and many others essentially say that. Critics say that market-based incentives would work better.

One irony is that Congress could without fear of constitutional invalidation have created the kind of single-payer system that conservatives call socialism.

Hudson stressed that as a matter of law, good policy is not necessarily constitutional, nor bad policy unconstitutional. But it’s pretty clear that he and Vinson think this law is bad both ways. And that Steeh and Moon think it’s good both ways.

Why do people keep saying the Supreme Court will decide the fate of the law in June 2012 or June 2013?

June is when the Court issues most of its big decisions, with some notable exceptions, whether they are argued in April or the previous October. That’s because big decisions tend to generate long opinions, dissents, and concurrences, which circulate back and forth as the justices trade debating points in footnotes. Decisions are almost never issued in July, August or September because the justices cherish their three-month summer vacations.

What has to happen before the Supreme Court gets the case?

U.S. Supreme Court

Photo: Franz Jantzen

While lots of cases are pending around the country, the four mentioned above seem to be on the fastest tracks. The Detroit and Lynchburg cases are already before or headed for the U.S. Courts of Appeals for the 6th and 4th Circuits, respectively. Hudson’s decision will also go to the 4th Circuit.

Vinson’s will go to the 11th Circuit no matter how he rules. And it often takes 14 months to two years for a case to move from the final ruling of a district judge such as Hudson to any decision by the Supreme Court.

Why does it take so long?

Judges and lawyers move very slowly. Allow four to five months for filing of initial briefs and responses in the appeals court. Three to eight more months for the three-judge panel to rule. Another four to six months for the losing side to seek and obtain (in a small percentage of cases) a Supreme Court decision to review the case. More than three additional months of briefing before the justices hear arguments.

But this timetable could slip by a year if the losing party in a regional appeals court panel obtains a rehearing before the full appellate court, or if the justices choose to await conflicting appeals court rulings rather than taking up the first case that comes along.

What’s likely to happen?

Lawyers in the Tallahassee case appear to have chosen Florida for a reason: The appeal of Vinson’s decision will go to the 11-judge U.S. Court of Appeals for the Eleventh Circuit, one of the most conservative in the country. Chances are good that a typical 11th Circuit panel will move fast, by judicial standards, to strike down the individual mandate.

Other cases may move fast, too. That would tee the issue up for a Supreme Court argument by the spring of 2012 and a ruling likely to fall between June 25 and 28 of that year.

Who will win?

The four justices will vote to uphold the law. Can they get to five? All eyes will be on their best bets: swing-voting Anthony Kennedy and Chief Justice John Roberts.

Taylor is a contributing editor for Newsweek and National Journal.

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

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Cheese

E. coli fears prompts recall of Washington state cheese

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Sally Jackson Cheeses of Oroville, Washington has issued a voluntary recall of all its cheeses after its products have been linked as a possible source for several cases of E. coli O157:H7 infection, a particularly dangerous kind of food poisoning.

Health inspections of the company’s facility concluded that “the products were processed under conditions that create a significant risk of contamination of the unpasteurized raw milk and finished cheese,” the FDA said.

The U.S. Food and Drug Administration (FDA) warns:

  • Consumers who have any Sally Jackson cheese should not eat it.
  • Restaurant operators and any other food-service operations that have any Sally Jackson cheese should not serve it.
  • Distributors should stop distribution.
  • To prevent people or animals, including wild animals, from eating the cheese, cheese that is not returned to the place of purchase should be disposed of in a closed plastic bag placed in a sealed trash can.

People who fall ill after eating food contaminated by E. coli O157:H7 typically develop abdominal cramps and diarrhea within three or four days. The diarrhea will often be bloody.

Most people recover within a week, the FDA said, but some have more serious infections and may develop a potentially fatal complication called hemolytic uremic syndrome, which can cause kidney failure.

E. coli

E. coli

Hemolytic uremic syndrome, or HUS, can develop in anyone but is most common in children under five years old and in the elderly. Symptoms of HUS can begin as diarrhea is resolving, the FDA said:

Signs and symptoms of HUS may include: fever, abdominal pain; pale skin tone; fatigue and irritability; small, unexplained bruises or bleeding from the nose and mouth; decreased urination and swelling of the face, hands, feet, or entire body.

Persons who experience these symptoms and believe they are at risk for HUS should seek emergency medical care immediately, the FDA said.

Sally Jackson Cheeses products include cow, sheep and goat cheeses. The products are wrapped in plain brown paper, twine and either grape or chestnut leaves. They do not have labels.

Sally Jackson Cheeses are distributed across the country including the Seattle area. A partial list of the states where these products are distributed is below. The FDA notes that this list may not be complete. The products are also available over the Internet.

To learn more:

______________________

FDA: Consumers should not eat Sally Jackson cheese due to risk of Escherichia coli O157:H7

Cheese was sold in multiple states Fast Facts

  • Sally Jackson Cheese of Oroville, Wash., has agreed to voluntarily recall all of its cheeses.
  • All Sally Jackson cheeses on the market should be avoided because the products were processed under conditions that create a significant risk of contamination, and because Sally Jackson cheeses have been identified as one possible source of several cases ofEscherichia coli (E. coli) O157:H7 infections. All Sally Jackson cheese is made from unpasteurized raw milk.
  • Consumers who have any Sally Jackson cheese should not eat it. Restaurant operators and any other food-service operations that have any Sally Jackson cheese should not serve it. Distributors should stop distribution. To prevent people or animals, including wild animals, from eating the cheese, cheese that is not returned to the place of purchase should be disposed of in a closed plastic bag placed in a sealed trash can.
  • People infected with E. coli O157:H7 can develop diarrhea (often bloody) and abdominal cramps for about 3-4 days, after ingesting the organism, but some illnesses may last longer and are more severe. Infection is usually diagnosed by culture of a stool sample. While most people recover within a week, some may develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur among persons of any age but is most common in children under 5 years old and the elderly. Signs and symptoms of HUS may include: fever, abdominal pain; pale skin tone; fatigue and irritability; small, unexplained bruises or bleeding from the nose and mouth; decreased urination and swelling of the face, hands, feet, or entire body. Persons who experience these symptoms and believe they are at risk for HUS should seek emergency medical care immediately.
  • FDA is inspecting the facility in collaboration with an investigation being conducted by the Washington State Department of Agriculture (WSDA). This inspection has identified conditions that create a significant risk of contamination.

What is the Problem?

The FDA, in cooperation with other state and local public health agencies, is warning consumers not to eat any Sally Jackson cheeses. The products were processed under conditions that create a significant risk of contamination of the unpasteurized raw milk and finished cheese, and Sally Jackson cheeses have been identified as one possible source of eight cases of E. coli O157 infections in an ongoing investigation.

Earlier this month, FDA was informed of an outbreak of E. coli O157:H7 infections by the Oregon Public Health Department (OPHD), WSDA, and the Washington Department of Health (WDOH). An investigation by these three state agencies and Public Health – Seattle and King County has identified eight ill persons with the outbreak strain who were ill between September and November.

Of the seven patients for whom food history is available, one person reported consuming Sally Jackson cheese, and four others may have consumed Sally Jackson cheese. Three of the four ill persons who may have consumed Sally Jackson cheese ate cheese from two restaurants serving Sally Jackson cheese, while the fourth tasted several cheeses that may have included Sally Jackson cheese.The remaining two patients consumed artisanal cheeses but do not know if it was Sally Jackson cheese. Analysis of cheese samples is currently in progress.

This warning is to protect consumers until more information becomes available. FDA completed its inspection today and issued a Form 483, Inspectional Observations, which is not a final agency determination regarding compliance. The inspectional observations include problems related to the sanitation of the facility, its employees, equipment, and utensils as well as problems with facility construction and maintenance.

Unpasteurized raw milk in raw milk cheese is obtained from cows, sheep, or goats and is not pasteurized to kill harmful bacteria. This raw, unpasteurized milk can carry dangerous bacteria such as Salmonella, E. coli and Listeria, which are responsible for causing numerous foodborne illnesses.

These harmful bacteria can seriously affect the health of anyone who drinks raw milk or eats cheese and other foods made from raw milk. The bacteria in raw milk can be especially dangerous to pregnant women, children, the elderly, and people with weakened immune systems.

What are the Symptoms of Illness/Injury?

Most people who develop illnesses caused by E. coli O157:H7 develop diarrhea (often bloody) and abdominal cramps for about 3-4 days, after ingesting the organism. Some illnesses may last longer and are more severe. Infection is usually diagnosed by culture of a stool sample.

While most people recover within a week, some may develop a severe infection. A type of kidney failure called hemolytic uremic syndrome (HUS) can begin as the diarrhea is improving; this can occur among persons of any age but is most common in children under 5 years old and the elderly.

Signs and symptoms of HUS may include: fever, abdominal pain; pale skin tone; fatigue and irritability; small, unexplained bruises or bleeding from the nose and mouth; decreased urination and swelling of the face, hands, feet, or entire body. Persons who experience these symptoms and believe they are at risk for HUS should seek emergency medical care immediately.

What Do Consumers Need To Do?

Based on currently available information and as a precaution to safeguard public health, FDA, OPHD and WSDA recommend that consumers not eat any Sally Jackson cheeses. To prevent people or animals, including wild animals, from eating the cheese, cheese that is not returned to the place of purchase should be disposed of in a closed plastic bag placed in a sealed trash can.

Where is it Distributed?

Sally Jackson cheeses have been distributed in several places, listed below.

This list may not be complete.

Numerous resellers can be found on the internet. The products include cow, sheep and goat cheeses produced by Sally Jackson Cheese of Oroville, Wash. The products do not have labels or codes, and are wrapped in plain brown paper, twine and either grape or chestnut leaves. Places where Sally Jackson cheeses are known to have been distributed or subdistributed include:

  • California
  • Colorado
  • Connecticut
  • District of Columbia
  • Hawaii
  • Illinois
  • Massachusetts
  • Minnesota
  • Missouri
  • Montana
  • New York
  • Oregon
  • Pennsylvania
  • Rhode Island
  • Texas
  • Virginia
  • Washington

What is Being Done to Protect Consumers?

Sally Jackson Cheese has agreed to voluntarily recall the products and to notify its customers directly. The FDA, WSDA, WDOH, OPHD, and public health agencies continue to collaborate in this ongoing investigation. Instructions to consumers may change as more information becomes available.

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Wyden, Ron

New law allows states to create their own health reform plans

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By Marilyn Werber Serafini and Mary Agnes Carey
KHN Staff Writers

Wyden: States Will Drive Support For Pre-Emption Bill

Sen. Ron Wyden, D-Ore., is seeking bold new authority for states to preempt the health care overhaul law as early as 2014, and he expects that governors will help pitch his legislation in Washington.

The new law gives states the ability to substitute their own reform plans in 2017 if, and only if, they can convince the federal government their approach would cover the same number of people with comprehensive insurance, and at a similar price.

States could even ditch the law’s controversial individual mandate that will require most people to purchase insurance.

But many states, including Oregon, he says, want this flexibility as soon as possible, and so he has introduced a bill with Sen. Scott Brown, R-Mass., to push up the date.

Last year, Wyden aggressively lobbied Senate colleagues on both sides of the aisle to support his Healthy Americans Act, a bill designed to move Americans away from the employer-based health care system. That measure gained little traction, but he believes many states will like his new legislation.

And his plans don’t stop there. He hinted that next year he might pursue a tax incentive to reward insurers that keep premium costs down.

KHN’s Mary Agnes Carey and Marilyn Werber Serafini recently spoke with Wyden. Edited excerpts of the interview follow.

Q: Why give states flexibility to try other approaches to health system change even before most of the national overhaul law takes effect?

A: This gives everybody a chance to show what works. … [For example,] you go out and talk to a bunch of conservative folks and they’ll tell you they want consumer-driven plans. They want tort reform. They don’t want a bunch of big, bumbling government [programs]. With this approach they can go to the legislature and say, ‘We can cover folks just like that bill in D.C., and give us a chance to do it.’ I think substantively this makes sense, I think politically it makes sense.

Q: Your mission during last year’s debate was to have personal conversations with nearly every senator about your Healthy Americans Act, which did not become law. What is your strategy for getting your new legislation into law?

A: My goal with Sen. Brown was to get it in so it started to percolate with the states and with the governors early on. What drives this is Republican governors, who are going to say, ‘You know, we’re not going to get repeal, we’d like to get out from under the individual mandate, and we hear there’s something back there that might give me a shot at doing it.’ The Vermont governor has already come on out and said, ‘I want to have a single payer system.’ [Oregon Gov.-elect John] Kitzhaber has already talked to [Health and Human Services Secretary] Kathleen Sebelius about his interest in some sort of waiver. Some [state officials] want to go earlier. What I’m talking about with Scott Brown kicks in in 2014. My governor probably wants a waiver in the next 15 minutes. I think you’re going to see early next year a significant amount of action at the state level with state legislators and governors.

Q: How can states get waivers to bypass the federal requirement that most people purchase insurance when states cannot guarantee ahead of time that they can meet the federal conditions? What happens if the state approach fails to cover as many people, for example?

A: [Sebelius] gets the last word. She has the authority to pull it. When you’re doing waivers and innovative work, you can say for certain that things always end up a little different than anticipated, but we tried to strike a balance between federal authority and state authority. You give the secretary the authority to have the last word. Then you have the review provisions, so if you’re not meeting your federal obligations, they can pull it at any point. It’s a pretty good balance, recognizing it’s a bit of an inexact science.

Q: Can you get bipartisan support for your proposal in the Senate, when an ideological battle over whether to repeal the law or move forward is in full swing? Sen. Robert Bennett, R-Utah, lost his GOP reelection bid after becoming the main Republican sponsor of the Healthy Americans Act. Will Republicans be reluctant to cross over and work with a Democrat on your new proposal?

A: There is no question that when folks try to find common ground, and try to find ways to work together, you put yourself out there, where the far right and the far left can take pokes at you. But I continue to believe that’s what the public wants. Read Bob Bennett’s farewell address on the Senate floor. He said he lost because of [the Troubled Asset Relief Program]. If you look at what happened in Utah, Bob Bennett faced a closed convention with a few hundred people who kept him from being on the ballot. Based on what I’ve seen, if Bob Bennett had had a chance to talk to the larger electorate, as a Republican nominee, he would have won by a bigger margin than I did, and I won 57 to 39 [percent].

Q: Are Democrats rethinking their support of the health overhaul’s individual mandate, which requires most people to purchase insurance by 2014?

A: I do think when you talk to people about whether or not there should be personal responsibility in health, people say people ought to be personally responsible. Much of this issue comes about if people are required to do something and they end up spending a lot of money for something they don’t much like, you bet they are going to be furious. This has been a flashpoint in the health care debate from day one. Everyone understood the tension between people being required to do something and the question of how do you come up with affordable coverage. I wanted to try to have something that might get some traction.

Q: What is the Democrats’ best defense against GOP attacks on the health law?

A: If you’re not for the president’s proposal people say what are you for? The country clearly does not want to go back to the days when you can hammer someone for a preexisting condition and you have a culture that essentially says the health care system works for you if you are healthy and wealthy. Piecemeal reform can be as complicated and as expensive and bureaucratic as [comprehensive] reform. It’s not going to be enough to have some pie in the sky ideas. If all they do is bring it down … I don’t think that’s going to fly.

Q: How can the government encourage health insurers to keep premiums down?

A: If premiums go up again, [insurers'] role will be front and center. You can almost follow the script, they will say the reason the premiums are going up is because of the law. Certainly they will get huge pushback. People will bring out their profits and the like. One of the things I’ve been looking at – I’m not ready to do – is that there are considerable taxes on insurers over the next few years. [But] if [insurers] hold their premiums down, they should pay less tax. If they don’t hold premiums down, they should pay more tax. I’m not proposing that today, I’m not introducing a bill on that. I’m going to look at it next year.


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

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King County restricts sale, use and distribution of electronic cigarettes

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Electronic CigaretteKing County will limit the sales of electronic cigarettes to adults only, prohibit the distribution of free samples, and restrict their use in public places and placed of employment.

Electronic cigarettes, or “e-cigarettes”, typically look like cigarettes but actually contain a battery-operated heating element and a replaceable cartridge containing nicotine. The element vaporizes the nicotine so it can then be inhaled like cigarette smoke. An LED light at the tip of the device lights up when the user inhales, mimicking the burning tip of a real cigarette.

Manufacturers of e-cigarettes say the products are safer than smoking regular cigarettes, but officials at the Food and Drug Administration (FDA) say the safety of these products is unknown.

Health officials are also concerned that the products, which are often marketed to teens, will lead to nicotine addiction causing many young people to take up smoking.

FDA video on e-cigarettes

Currently, e-cigarettes are under investigation by the FDA, but are currently not subject to federal regulation. As a result, they can be sold to teens and marketed anywhere. They are often sold at shopping mall kiosks and in convenience stores. They are often candy-flavored, which appeals to the young.

In a unanimous vote today, the King County Board of Health voted to:

  • restrict the sales of e-cigarettes or any other unapproved nicotine delivery devices only to people 18 and older;
  • prohibit free or highly discounted electronic smoking devices or unapproved nicotine delivery products;
  • prohibit the use of e-cigarette devices in places where smoking is prohibited by law.

“No matter how it’s delivered, nicotine is highly addictive. We took an important step today to keep these unknown products out of the hands of kids in King County,” said Boardmember and Lake Forest Park Mayor David Hutchinson, after the vote.

Electronic Cigarette

Electronic Cigarette

“This Board of Health proposal is a reasonable step to protect youth immediately in King County while federal authorities continue to look into these products,” said Dr. David Fleming, Director and Health Officer for Public Health – Seattle & King County. “Through this regulation, young people in King County have one less opportunity to get hooked on nicotine.”

The Board of Health convened a Tobacco Policy committee in June 2010 to review the evidence and develop new tobacco policies that respond to current policy opportunities and disparities in King County. Today’s regulations were endorsed by the committee members.

Several other jurisdictions across the nation have created similar regulations related to e-cigarettes but it is believed that King County’s new regulations are the most comprehensive in the nation, health officials said.

To learn more:

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U.S. Supreme Court

Experts ponder ‘plan B’ options for the individual mandate

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By Joanne Kenen

U.S. Supreme Court

Photo: Franz Jantzen

With Republicans vowing to dismantle the health law and courts wrestling with its constitutionality, some health policy experts are pondering a possible “Plan B” in case the individual mandate – the requirement that everyone get health insurance starting in 2014 – is weakened or struck down.

One idea is to raise everyone’s taxes – and then give big tax breaks back to people who get insurance. Other proposals include creating strict open-enrollment periods so that people can’t game the system, or an opt-out mechanism carrying stiff consequences for people who decline to get covered.

It’s far from clear, however, that any political consensus could be reached on tweaking or replacing the mandate. Many advocates of the mandate say it’s still the best way to get as many people covered.

In addition, some economists and policymakers are concerned that the mandate’s penalties were watered down too much during the arduous congressional debate.

Gail Wilensky, a former director of Medicare and Medicaid under President George H.W. Bush, has suggested that well-crafted carrots and sticks could get the same job done. As a model, she pointed to the Medicare drug benefit that charges people more if they don’t get coverage when they become eligible, but decide to get it later. That template could apply for health insurance too, with the penalty lasting for three to five years.

“The idea is to raise the ante for people who wait until they are sick to buy insurance,” Wilensky said. “That would change the dynamics and may be more effective than a wimpy mandate,” she said.

The mandate is intended to expand coverage, prevent the uninsured from passing the costs of their care to everyone else, and make insurance markets work better by having risk shared by old and young, sick and healthy.

Under the law, in 2014, an individual’s penalty for not having insurance could be as little as $95. By 2016, it would be $695 or 2.5 percent of taxable income, whichever is greater.

Critics on both sides of the political spectrum have assailed the mandate. Conservatives have attacked it as government coercion while some on the left see it as a giveaway to private insurance companies who would profit from the business created by millions of new customers.

Many lawsuits have been filed seeking to overturn the mandate, and the issue is expected to eventually wind up at the Supreme Court.

Under the law, in 2014, an individual’s penalty for not having insurance could be as little as $95. By 2016, it would be $695 or 2.5 percent of taxable income, whichever is greater.

“My view is that this (mandate) is much more symbolic. The actual penalties involved are relatively mild.”

“The mandate’s been oversold,” said Mark Pauly, a health care economist at the University of Pennsylvania’s Wharton School who was one of the scholars who initially put forth the individual mandate idea while also serving in President George H.W. Bush’s administration. He still supports the concept, if properly designed.

“My view is that this (mandate) is much more symbolic. The actual penalties involved are relatively mild,” he said, and aren’t big enough to compel “people who are reluctant to pony up for insurance anyway.”

Pauly also criticized the way the law paired the mandate with new rules he regards as too expansive.

For example, it will be too easy, in his view, for people to delay buying coverage until they get sick – and without paying much more if they are older or sicker, precisely the behavior that the overhaul is supposed to discourage. Pauly has advocated having some of the sickest people covered in special high–risk pools.

The insurance industry accepted new rules and regulations, including the requirement that they sell health plans to people with preexisting conditions, because the mandate would enhance its market.

Princeton sociologist Paul Starr, who was a senior health adviser to President Bill Clinton, anticipated the risk of political backlash even before health law was passed. He outlined a more flexible alternative aimed at quelling political fires while still expanding the insurance pool.

Except for the poor (people making less than $9,350 and couples earning less than $18,700 are not subject to the mandate but would be eligible for coverage under Medicaid), people would have three choices, Starr said. They could buy insurance, with subsidies if they qualify. They could pay an annual tax penalty for going uninsured. Or they could opt out with no penalty – but they couldn’t opt back in for five years.

Those who opt out wouldn’t be eligible for any subsidies in the exchanges. And under this scenario, they wouldn’t be covered by one of the most popular protections in the legislation — the ban on insurers excluding people with pre-existing conditions.

You need a mandate because there will be some Evel Knievels of health insurance.”

People who opted out could still shop for insurance, but there would be no guarantee that they could find an insurer to cover them, at a price they could afford.

Despite what happens to the mandate, there’s a lot more to the health law, noted John Holahan, director of the Health Policy Center at the Urban Institute.

Without the mandate, he said, there probably would be more free riders, whose costs would be passed onto taxpayers and insured consumers. But of the 32 million people projected to gain coverage, the majority will either be eligible for expanded Medicaid or subsidized policies they can buy in the exchange.

The exchange itself, along with new rules for insurers, will change the nature of the insurance market.

The expansion of “Medicaid would stay. Subsidies would stay. Some healthy people won’t take them (subsidies) up, but the market will be a better market than it is today,” Holahan said. “I think you’d end up getting a lot of coverage through exchanges.”

Pauly, who has seen Republican enthusiasm for the individual mandate ebb and flow over the years, still thinks the idea is crucial.

“You need a mandate because there will be some Evel Knievels of health insurance.” Risk eventually catches up with the risk takers, he said. And when that happens, someone pays.

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

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ACP/AARP How Health Care Reform Might Affect You

A simple guide to the new health-care reform law

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ACP/AARP How Health Care Reform Might Affect YouConfused? The American College of Physicians and AARP have put together a simple five-page guide that explains how the new health-care reform bill will affect you.

In a simple question-answer format the guide addresses questions most people have about the new law’s provisions, why they were created and when they are scheduled to come into effect.

The guide, The New Health Care Law: How It Might Affect You, comes in an English and a Spanish version.

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“Plain English” charts will make comparing insurance plans easier

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State Insurance Officials To Vote On Rules For Descriptions Of Health Policies

By Susan Jaffe – KHN

Choosing a health insurance policy should be easier if consumers use the simple chart and other information that state insurance commissioners are expected to approve today.

“It will force the insurance companies to reveal information in a consistent way,” says Bonnie Burns, a policy specialist for California Health Advocates, a consumer health advocacy group. “And it should make it easier for people to understand what they’re getting and not getting.”

Click on image to see the full chart

Under a little-known provision of the health overhaul law, insurers will be required to provide their benefits information on a standardized chart using the same plain English terms as other companies to help shoppers understand and compare complicated policies.

Congress even listed some of the insurance jargon – including terms such as deductible, preferred provider, excluded services and UCR (usual, customary and reasonable) – that must be defined in a glossary that will accompany the benefit summary.

It directed the National Association of Insurance Commissioners to form a group to develop the materials and specified that the group include state insurance regulators, consumer and patient advocates, insurance companies and health care providers.

After the vote, the materials, which were adopted unanimously by the working group, will be sent to the Department of Health and Human Services and Department of Labor. Those departments will issue regulations spelling out how insurance companies and employers must use the materials. The new system must be in place by March 2012.

“Right now I think it’s really hard for buyers today to shop for coverage, compare apples to apples and make smart decisions,” says Mila Kofman, Maine’s superintendent of  insurance and a co-chair of the working group.

Only a handful of states require health insurers to distribute information that meets “readability standards,” she says.

It wasn’t easy for the group to decide what information consumers needed when choosing a policy and to translate insurance jargon “so that a normal person understands what it is,” says Kofman. The group’s nearly four dozen members held 25 meetings and conference calls, some as long as six hours.

“It’s a great way to educate consumers about insurance,” says Randy Kammer, a vice president of Blue Cross Blue Shield of Florida and a member of the working group.  It tells them what kind of information they need to consider when choosing a policy and “will create incentives for them to look deeper.”

The draft benefits summary and a glossary of definitions were tested on consumers in focus groups in the fall by Consumers Union and the America’s Health Insurance Plans, an industry group.  Their reactions prompted some refinements.

The law even forbids the dreaded “fine print,” by specifying at least a 12-point type size (larger than typical newsprint). Any exceptions or limitations to coverage must be included along with the out-of-pocket costs that plan members can expect to pay.

Examples of the costs for some common medical treatments must also be provided in a separate “coverage facts label” modeled after the nutrition facts label that appears on prepared foods.  Kofman says the group has not finished its work on the label.

Kofman does not expect the government to make many changes when it reviews the consumer materials since federal officials participated in the development process.  “The feedback we had from them was very positive,” she says.

Karen Pollitz, the deputy director for consumer support in the HHS Office of Consumer Information and Insurance Oversight, is one of the officials who will review the materials, says Kammer.  Pollitz helped develop the concept of a coverage facts label when she was a research professor at Georgetown University’s Health Policy Institute.

Pollitz spoke to the working group in September about the idea and co-wrote a report last year that highlighted consumers’ need for better insurance information.

Choosing the wrong policy can have consequences. For example, when comparing breast cancer treatment coverage under three California policies, the study found that a patient would spend nearly $4,000 for a typical treatment under one policy or as much as $38,000 under another even though both policies had similar deductibles and out-of-pocket limits.

“Health insurance should be transparent, so that consumers know what they are getting in a market filled with options that are not always equal,” the researchers concluded.

Susan Jaffe can be reached at jaffe.khn@gmail.com.

To learn more:

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

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Virginia Mason Medical Center hires new primary care physicians

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Seattle’s Virginia Mason Medical Center has hired four new primary care physicians.

Dr. Christopher Berlin VM

Dr. Christopher Berlin

Dr. Christopher Berlin joined Virginia Mason in General Internal Medicine and is practicing at Virginia Mason Federal Way. Berlin received his doctorate of medicine degree from Northwestern University in Chicago and completed his residency training at the Hospital of University of Pennsylvania in Philadelphia. He is board certified in internal medicine.

Dr. Joy Bucher

Dr. Joy Bucher

Dr. Joy Bucher joined Virginia Mason in General Internal Medicine and is practicing at the Seattle Main Clinic. Bucher received her doctorate of medicine degree from the University of California, San Francisco, and completed her residency training at the University of Washington. She is board certified in internal medicine.

Dr. Lars Kaine

Dr. Lars Kaine

Dr. Lars Kaine joined Virginia Mason in Family Medicine and is practicing at Virginia Mason Kirkland. Kaine received his doctorate of medicine degree from the University of Arizona College of Medicine in Tucson and completed his residency training at St. Joseph’s Hospital & Medical Center in Phoenix. He is board certified in family medicine.

Dr. Yukmila Soriano VM

Dr. Yukmila Soriano

Dr. Yukmila Soriano joined Virginia Mason in General Internal Medicine and is practicing at the Seattle Main Clinic. Soriano received her doctorate of medicine degree from Albert Einstein College of Medicine in New York and completed her residency training at Columbia University Medical Center in New York. She is board certified in internal medicine. She is also bilingual in Spanish and English.

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Is the individual mandate really a lynchpin in the new health law?

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Robert Laszewski, President of Health Policy and Strategy Associates

If the Supreme Court does rule the individual mandate unconstitutional will it really bring down the whole law?

I don’t see it.

First, the individual mandate isn’t even close to what it has been made out to be — a provision that would protect the integrity of the health insurance market by forcing people to buy health insurance before they became sick.

So, under the health law’s individual mandate, this $55,000 family would likely pay no more than $550 in fines the first year, $1,100 the second year and $1,375 in fines the third and subsequent years

At best, it’s a tepid attempt at that.

The individual mandate’s fine for not buying coverage is 1 percent of family income or $95 for each family member not covered, whichever is greater in 2014; 2 percent of income or $325 per family member, whichever is greater in 2015; and $695 or 2.5 percent of income or whichever is greater in subsequent years (kids are half price!).

These are meaningful fines for not buying insurance, but only a fraction of what a consumer would pay for health insurance.

Here’s how the individual mandate’s fine for non-compliance actually works for a number of representative family income levels based upon 2010 incomes and poverty levels:

Alternatively, here is what families would be required to pay under the health law toward their health insurance premiums based upon their total family income — net of the federal subsidy — in 2010 dollars:

A family of four making $55,000 per year is at 250 percent of the federal poverty level this year. Based upon today’s incomes, the maximum they would pay in the exchange for health insurance is 8.05 percent of their income, net of the federal subsidy — $4,428 annually.

So, under the health law’s individual mandate, this $55,000 family would likely pay no more than $550 in fines the first year, $1,100 the second year and $1,375 in fines the third and subsequent years; or, alternatively, have to pay $4,428 for insurance net of the federal subsidy in the exchange.

A family making $85,000 a year (400 percent of poverty) would have to pay $8,075 for their share of the cost of health insurance in the exchange or likely pay a fine in the first year of $850 that would likely cap out at 2.5 percent of $88,000, or $2,125, in later years.

Families would also have to pay their share of deductibles and co-pays within the insurance policies they purchased.

The fine families would pay for ignoring the individual mandate to purchase health insurance is significant but only a fraction of what the insurance would cost.

If the individual mandate is eventually held unconstitutional by the Supreme Court there will be attempts to substitute an alternative means to protect the insurance market from the “anti-selection” that would occur as people held back on purchasing health insurance until they needed it.

One possible alternative to the individual mandate would be to allow consumers to purchase coverage only at limited open enrollment periods — buy it now or you won’t be able to get it when you get sick.

Given how tepid the current individual mandate penalties are, such an alternative scheme could be much more effective in protecting the insurance markets, as well as far more politically palatable for consumers faced with paying either an unaffordable insurance fine or an even more unaffordable insurance premium, than the current weak individual mandate before the courts.

All of the focus on the recent Richmond federal court ruling misses the big picture on health insurance affordability under the new law: Many middle class families will not be happy with or be able to afford the fines nor will they be able to afford the much higher cost of health insurance — even after the federal subsidy.


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

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Illustration showing two people biking.

Making your New Year’s resolutions stick

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NIH News in Health

Illustration showing two people biking.

Making Your Resolutions Stick
How to Create Healthy Habits

New Year’s resolutions—they’re easy to make but easier to break. Why is it so hard to make the healthy changes that we know can help us feel better and live longer?

And why is it so hard to make them last? NIH-funded scientists are learning more about how we can make healthy changes and, even more important, how we can sustain them.

“Change is always possible,” says Dr. Linda Nebeling, an expert in behavioral change and nutrition at NIH. You’re never too out-of-shape, too overweight or too old to make healthy changes.

Some of the most common New Year’s resolutions are losing weight, getting more physical activity, eating more nutritious foods, quitting cigarettes, cutting back on alcohol, reducing stress and sleeping better.

But no matter which healthy resolution you choose, research suggests that some common strategies can boost your chance of making the change a habit, a part of your daily lifestyle.

“One challenge with New Year’s resolutions is that people often set unrealistic goals. They can quickly become frustrated and give up,” says Nebeling. “Any resolution to change needs to include small
goals that are definable and accompanied by a solid plan on how you’ll get to that goal.”

For instance, a resolution to lose 30 pounds may seem overwhelming. Instead, try setting smaller goals of losing 5 pounds a month for 6 months. Think baby steps rather than giant leaps.

Making Healthy Changes

  • Set realistic goals. Write down the steps that will help you achieve them.
  • Plan for obstacles. Figure out how to overcome them. Don’t give up just because you’ve slipped.
  • Track your progress. A journal or diary is one of the best tools for helping you stay focused and recover from slip-ups.
  • Get help. Ask friends and family for support. Consider enrolling in a class or program.
  • Reward yourself. Give yourself a healthy treat when you’ve achieved a small goal or milestone.
  • Add variety. Keep things interesting by adding new activities or expanding your goals to make them more challenging.

Next, develop an action plan. You might decide to walk a half hour each day to burn calories. You might stop buying vending machine snacks. Or you might limit and keep track of your daily calories.

“These are specific behaviors that could help you meet your larger goal of losing 30 pounds,” says Dr. Deborah Tate, an obesity and behavioral researcher at the University of North Carolina.

To make a long-lasting change in your life, prepare yourself for the challenges you might face. “Think about why you want to make the change. Is it important to you, or is it mostly influenced by others—like your doctor, your spouse or a friend?” says Tate. “Research suggests that if it’s something you really want for yourself, if it’s meaningful to you, you’re more likely to stick to it.”

Think of exactly how the change will enhance your life. For instance, when you stop smoking, your risk plummets for cancer, heart disease, stroke and early death. Reducing stress might cut your risk for heart disease and help you fight off germs.

Even small improvements in your physical activity, weight or nutrition may help reduce your risk for disease and lengthen your life.

In one study, overweight or obese people who lost just 7% of their body weight slashed their risk for diabetes by nearly 60%. Keeping facts like this in mind can help you maintain your focus over the long haul.

Setting up a supportive environment is another step toward success. “Think about the physical support you’ll need, like the right equipment for exercise, appropriate clothing and the right kinds of foods to have at home,” says Dr. Christine Hunter, a behavioral researcher and clinical psychologist at NIH. Remove items that might trip up your efforts. If you’re quitting smoking, throw away your ashtrays and lighters. To improve your nutrition, put unhealthy but tempting foods on a hard-to-reach shelf, or get rid of them.

Social support is also key. Research shows that people’s health behaviors—like smoking or weight gain—tend to mirror those of their friends, family and spouses.

“You can enlist friends and family to help you eat better, to go on walks with you, to remind you to stay on track,” says Tate. “Find things that are fun to do together, and you’ll be more likely to stick with it.”

“It helps when you’re connected to a group, where lifestyle change like weight loss is a joint goal,” says NIH’s Dr. Sanford Garfield, who heads a large study called the Diabetes Prevention Program.

Participants who lost weight through dietary changes and physical activity reduced their chances of developing diabetes. Group counseling that emphasized effective diet, exercise and behavior modification were credited, in part, with participants’ success.

“There’s a long history of group support leading to good results,” Garfield says.  “People learn from each other and reinforce each other in working toward their goals.”

While making a change is one thing, sticking to it is something else. “Maintaining a change requires continued commitment until the change becomes a part of your life, like brushing your teeth or washing your hair,” says Nebeling. “People who can maintain or engage in efforts to change their behavior, and do it for 6 to 8 weeks, are more likely to be able to support that effort longer term.”

Some researchers are studying people who’ve made lasting healthy changes. The ongoing National Weight Control Registry compiles information on more than 5,000 adults who’ve dropped at least 30 pounds and kept it off for a year or more.

Although the way these people lost their weight varied, those who’ve maintained their weight loss tend to use similar strategies. Notably, many participants track their progress closely, often in a daily journal or diary. If the numbers rise, they have an early warning to adjust their behaviors.

“Self-monitoring or tracking seems to be critical for almost every sort of behavior change,” says Hunter. That includes jotting down the foods you eat, keeping an exercise diary or making a record of your sleeping patterns.

Monitoring yourself might feel like a burden, but it’s one of the best predictors of successful change. “Think about how you can make tracking more convenient, so it fits naturally into your life,” Hunter says. For some people, that might be a pad of paper in a purse or pocket; for others, a mobile app or a computer program.

Make sure to have a plan to get back on track if you start to slip. “If you feel that your motivation is waning, think back and remind yourself why the change was important to you in the first place,” says Tate. “Maybe you wanted to have more stamina, feel better, to be able to play with grandchildren. Recalling these personal reasons can encourage you to get back on track.”

Of course, you don’t need a new year to make healthy changes; you can make them any time of the year. But New Year’s is an opportunity to think about the improvements you’d like to make and then take concrete steps to achieve them. Set realistic goals, develop an action plan and set it in motion. Make your new year a healthy one.

To learn more:

NIH News in Health is a monthly newsletter from the National Institutes of Health, part of the U.S. Department of Health and Human Services, To visit the newsletter’s website go here.

Editor: Harrison Wein, Ph.D.
Assistant Editor: Vicki Contie

Contributors:

  • Vicki Contie
  • Alan Defibaugh (illustrations)
  • Bryan Ewsichek (design)
  • Harrison Wein
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Few seniors buying long-term care insurance

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By Michelle Andrews

People don’t like to think about what will happen if they become too ill or infirm to manage on their own. Experts say that partly explains why sales of long-term-care insurance policies are so anemic; only about 10 percent of seniors have such coverage.

Given the complexity of these policies, experts agree it’s tough to decide whether they’re right for you. The policies have many moving parts: After a waiting period, they generally pay a set daily benefit for a certain number of years. They typically cover care in a nursing home, an assisted living facility or at home.

They also tend to have high premiums. A 60-year-old might pay $200 a month for a policy that pays $150 a day for a maximum of three years, according to a 2009 study by Avalere Health, a research and consulting firm, and the Kaiser Family Foundation. (Kaiser Health News, which produces this column, is a program of the foundation.) Purchasing at a younger age can help trim premium costs.

But since people typically don’t make a claim until they’re 80 years old or so, that can be a long lead time, especially when you’ve got college tuitions to pay or may be worried about losing your job.

Video: Should you buy a long-term care insurance policy?

Recent turmoil in the long-term-care insurance market adds further uncertainty. MetLife, one of the largest carriers, announced it will no longer sell the policies starting next year, and John Hancock, another major issuer, has asked regulators for premium increases averaging 40 percent for 850,000 policyholders.

In the future, people may be able to take advantage of the Community Living Assistance Services and Support Act, or CLASS Act. This is a program created under the new health-care law to help people with functional or cognitive impairments pay for nonmedical services to help them stay in their homes. The money can also be used to cover nursing home care.

Premiums and benefits have yet to be set, but one estimate, by the Congressional Budget Office, suggested a cash benefit averaging $75 a day. Enrollment won’t begin until 2012 at the earliest, however, and people will have to pay premiums for at least five years before they’re eligible to receive benefits.

What’s a consumer to do in the meantime?

More From This Series: Insuring Your Health

Unfortunately, existing government programs aren’t much help to middle-income people.

Medicare provides only limited nursing home and home health care coverage.

Medicaid, the health insurance program for low-income people, pays for about 70 percent of nursing home patients.

But in order to qualify, people must generally have no more than a few thousand dollars in assets.

“People need to think about it very holistically,” says Anne Tumlinson, senior vice president for long-term care at Avalere Health. For many people, that’s going to mean patching together a safety net that consists of savings, caregiver help from friends and family, support from local community services and perhaps long-term-care insurance.

Care isn’t cheap. In 2009, the average cost for a home health aide was $21 an hour, according to the Department of Health and Human Services. A private room in a nursing home cost $219 daily on average, though there are wide variations depending on location. A one-bedroom unit in an assisted living facility was $3,131 per month, on average.

Two years ago, when her mother was in the last stages of Alzheimer’s disease, LuMarie Polivka-West’s parents sold their home and moved to an assisted living facility in Tallahassee. After her mother’s death last year, Polivka-West and her two brothers moved their father, now 96, to another assisted living facility a bit closer to LuMarie’s home.

LuMarie and her two brothers help supplement their dad’s $1,600 monthly Social Security check and the money left from the sale of his home to cover his living expenses, including the $3,400 monthly charge at the assisted living facility.

As a nurse practitioner, her younger brother is able to manage their father’s medications, saving him the $600 a month that the assisted living facility would charge for this service.

The family discussed buying long-term-care insurance at one time but decided against it, partly because of the cost.

“My parents planned well, but they lived longer than expected,” says LuMarie. Her father’s assets will run out in two to three years. “We’ll help maintain Dad in the assisted living facility as long as possible,” she says.

About 10 years ago, Charline Hines and her husband also discussed buying a long-term-care policy. But they made the opposite decision: They bought one. Hines says the policy was useful when her husband was dying of Parkinson’s disease a few years ago and had to go into a nursing home near their home in Grand Prairie, Tex.

But Hines, 78, just received a notice that her premium was going up in January, from $2,772 a year to $3,132. Now she’s seriously considering dropping the policy.

“I feel it’s time to just let it go,” she says.

For people who are considering buying a policy, call a few local facilities to get an idea of costs in the area. Since the average stay in a nursing home is about 2.5 years, many experts advise buying a policy that will provide benefits for about that long.

Inflation protection is also key, to keep pace with rising costs. A policy with 5 percent compound inflation protection is the gold standard.

Look for a company with strong financial ratings and a history of stable rates. New York Life and Northwestern Mutual, for example, have never raised premiums on existing policies.

Those companies are the exception, however. If you buy a long-term-care policy, expect that premiums will go up.

“I’m telling people now that they need to build a 50 percent rate increase into their planning,” says Bonnie Burns, a specialist with California Health Advocates, an advocacy organization.

To learn more:

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

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Video: ‘Individual Mandate’ in health law is unconstitutional, federal judge rules

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U.S. District Court Judge Henry Hudson in Virginia has struck down a key part of the new health law, saying that the law’s mandate requiring most Americans to buy health coverage is unconstitutional.

In this video, KaiserHealthNews reporter Jackie Judd interviews lawyer and journalist Stuart Taylor about the decision and its possible impact.

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

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