Seattle Children’s doctor offers tips to keep kids safe this holiday season

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Photo courtesy of Jay-Simmons

Photo courtesy of Jay Simmons

From Seattle Children’s On the Pulse blog

Tis the season for mistletoe, gingerbread and carefully strung lights. It’s the most wonderful time of the year, but also a potentially dangerous one for children. And although festivities, candles and garland may make the holiday season more cheerful, with them come some serious safety concerns.

Tony Woodward, MD, MBA, medical director of emergency medicine at Seattle Children’s Hospital, says the most important thing to remember this holiday season is supervision.

“The holidays are a fun and exciting time, but there are a few more things inserted into the environment, like holiday plants, electrical cables, new toys and festive beverages, which are potentially dangerous,” says Woodward.

Holiday safety tips

To keep kids out of the emergency room this year, Woodward recommends some basic safety tips to ensure an injury-free, but still festive holiday season.

Lights, trees and décor. Sparkly ornaments, shiny holiday decorations and small holiday figurines are potential choking hazards for small children. If an object can fit through a toilet paper tube, it can obstruct the airway of a small child and prevent breathing.

“Think like a child,” says Woodward. “Get down on your hands and knees and look around the house. If something looks shiny and enticing, a child may want to put it in their mouth. Keep decorations high and out of reach.”

Make sure trees and decorations are properly secured, either by a sturdy stand or to the wall. Also, talk to children about holiday decorations and explain that they are not toys. Set limits and supervise children.

Poisoning potential. Holiday plants like mistletoe, holly and poinsettias are commonly used as decorations, but they can be hazardous to children. These plants are considered potentially poisonous and should be kept away from children and out of reach. If a child ingests any part of these plants call a pediatrician or the Poison Help Line immediately at (800) 222-1222. Symptoms from poisoning may include vomiting, diarrhea, nausea or rash.

Medicines and vitamins can also be hazardous for children. Keep an eye out for medicine, vitamins and other personal products found in purses or suitcases that guests visiting for the holidays may bring into the home. Also, be aware when visiting other houses this holiday with your family, especially households without young children because the house may not be child proofed.

Be cautious of raw or undercooked foods during the holidays. Wash hands frequently when handling raw meat or eggs, and don’t leave foods out in reach of children.

Holiday parties. Hosting a holiday gathering this year? Plan for a party’s youngest guests first. Take small children into consideration when planning a party’s food and beverage menu, and before adorning the home with festive décor.

“Decorating the home with garland and strung beads may look great for the holidays, but children can mistake the brightly colored beads and floral arrangements for candy or food, which may cause choking or poisoning,” says Woodward.

Alcohol is another common risk for children around the holidays and during holiday gatherings.

“Kids see adults drinking alcohol and become curious. If glasses are left sitting out in reach of children they may ingest the alcohol, which even in small amounts can be dangerous to kids. Use common sense and always keep an eye on children,” says Dr. Woodward.

Also, stay home from parties or gatherings if children aren’t feeling well. Don’t risk spreading germs to others. Talk to children about proper hand washing and coughing techniques. Germs are easily spread, but these techniques can help prevent the transmission of germs from one person to another.

Fire safety. Keep decorations and trees away from heat sources within the home, which includes fireplaces, radiators, space heaters or electrical outlets. Also, avoid using candles if there are small children in the home.

When buying an artificial tree, make sure it is “fire retardant,” and also make sure a child’s sleepwear is labeled “fire retardant” as well. Be sure to also remove dry trees after the holiday season to reduce fire risk.

Use socket covers to baby-proof electrical outlets and make sure extension cords are well hidden and out of reach. Ensure cords are all the way in the outlets so kids don’t get shocked. Also, do not have water around outlets and wires.

Cooking is the leading cause of home fires in the U.S. Try to keep small children out of the kitchen while cooking or preparing food. Turn pot handles in so they can’t be accidently knocked over and stay in the kitchen while frying, grilling and broiling.

Toy safety. Many toys and holiday decorations require button batteries, which can pose fatal risks for young kids. Be sure batteries cannot be removed easily from toys and gadgets. If a battery is swallowed, it can cause life-threatening injuries. Also, avoid magnets. Toys that contain small magnets are especially dangerous for young kids. If swallowed, magnets can attract to one another in a child’s intestine and cause serious complications and even death.

“Make sure toys are appropriate for the age of a child, but also think about other children,” says Woodward. “Think about the worst case scenario. If a 1-year-old or 2-year-old will be in the home visiting for the holidays, ask if there are toys that could potentially be harmful to them.”

Just like checking a food’s ingredient list, parents should read toy and product labels. Avoid toys and products that contain PVC plastic, xylene, toluene or dibutyl phthalate.

Cold weather. With temperatures dropping, make sure children are properly dressed for the weather with hands, feet and heads covered. Dress children in layers and make sure they come in out of the cold periodically. The nose, ears, feet and hands are at the biggest risk of frostbite if temperatures are below freezing.

Supervise children while they play. Activities like sledding can be dangerous without proper supervision and safety gear. Also, be extremely cautious around water. Never allow children to walk across frozen lakes or ponds.

Lastly, wear sunscreen. It may be cold, but children are still at risk for sunburn.

The holidays are a time for celebration and fun. By following these simple safety tips, families can enjoy the holiday season without injury. Happy Holidays!

Photograph courtesy of Jay Simmons

Resources:

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Universal Human Rights and the Northwest – Viewpoint

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 By Dr. J. Carey Jackson, M.D

The Universal Declaration of Human Rights was signed on December 10th 1948  in response to the horror of the second world war. Thereafter December 10th  has been observed as International Human Rights Day. This year it is a somber anniversary as we also grieve the passing of Nelson Mandela, a remarkable champion of human rights.

One can’t remember Mandela without also remembering the brutal manner in which his rights were violated by the South African government. A government that should have served the people of South Africa and which instead treated the black majority with contempt. For decades, he and the other leaders of his political party, the African National Congress were hunted, imprisoned, and tortured.

We want to take this opportunity to make the public aware that this past year in Seattle  a new coalition was formed to assist survivors of human rights violations like these who seek refuge in the northwest region.

The Northwest Health and Human Rights Coalition brings together three organizations that have served refugees for decades: International Counseling and Community Services, the Northwest Immigrant Rights Project, and Harborview Medical Center’s International Medicine Clinic.

These organizations respectively address the mental health, social, medical, and legal needs of survivors of torture referred to them for care.  A $300,000 grant to Lutheran Community Services supports a formal collaboration between these three entities allowing for easy referrals between them.

The grant  also supports ongoing educational outreach to psychologists, physicians and lawyers to make them aware of torture, it’s consequences, and pearls of evaluation and management.

The coalition has been in place for only a year but in this time has served 250 unique torture survivors.  In some cases people need asylum, in others they have legal status, but have chronic pain or disability from deprivation or abuse. Others need mental health services, evaluations, and medication. Often they need all three.

Seventy thousand refugees will be allowed to enter the U.S. this year. Two thousand will come to Seattle, and others will relocate here after arriving elsewhere.

Depending on the country of origin an estimated 5% to 35% of refugees meet criteria for torture.  There are an estimated 500,000 people who have survived torture living in the United States.

Some of the people the coalition has been able to help:

K.D:

K.D was a driver in Ivory Coast and was captured by the opposition government and imprisoned, stripped, and intermittently electrically shocked  for 11 days. He eventually escaped and ran through the bush to neighboring Gambia. From that moment on he was unable to contact his three children, pregnant wife, or family.  Upon arrival  in New York he was held in the Brooklyn detention facility for a year until he was granted asylum. He then was able to work, and came to the northwest for the fishing industry in Alaska. He came to Northwest Health and Human Rights for mental health support, and for medical evaluation so he could work.

D.K.:

D.K. is an Eritrean man who had been repeatedly harassed by the military because his brother had defected. To survive, he attempted to escape Eritrea and so walked to Sudan, then traveled by truck to Libya. He was imprisoned and abused in each country by the authorities because he was undocumented. Sent back to Eritrea on one occasion, only to repeat the experience until he was able to take a boat to Malta.  Starved, beaten, imprisoned in crowded inhuman conditions, like so many, he  now has night mares, guilt, anxiety ,and chronic pain.

 S.M.:

S.M. is an Iranian dissident, now a refugee, who was repeatedly arrested and beaten, imprisoned, and on one occasion so badly injured that metal plates were used to reconstruct his face. He has chronic headaches, nightmares, anxiety, and complications from his reconstructive surgeries.

Each of these cases came to the Northwest Health and Human Rights Coalition in the past year for coordinated care of their unique problems and each received it.  MRIs, labs, specialty procedures, mental health assessments and treatment, and legal defense when needed.

At this anniversary of universal human rights, as we grieve the passing and celebrate the life of a great man, even as the newly formed collaborative effort called Northwest Health and Human Rights  strives to embody Mandela’s ideals as well as our own. We strive to provide support to those who have come to the United States for protection and to assure theme that continually…

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.–That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed,”

 

Carey JacksonJ. Carey Jackson, M.D., M.P.H., M.A., is a Professor of Medicine, the Medical Director of the International Medicine Clinic, the Director of the Community House Calls Program and Director of Interpreter Services at Harborview Medical Center. He received his M.P.H. in Epidemiology at the University of Hawaii and continued on with his M.A. in Anthropology and his M.D. at Michigan State University. He completed his residency at the University of California, Irvine. His professional interests center on refugee and immigrant health, health services delivery to the non-English speaking poor and medical anthropology.

 

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Healthcare.gov: New features to improve function

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After a disastrous launch of its health insurance exchange, Healthcare.gov, the administration has worked to revamp the site. Here are some of the new features:

From Healthcare.gov:

Here are some of the new features you’ll find on HealthCare.gov:

More robust window shopping. You can now see detailed information about each Marketplace health insurance plan offered in your area before you apply. This new tool will allow you to see plan prices displayed much more accurately, based on the household information you supply. You can compare plans, covered benefits, physician and hospital networks, and more. No login or application required. Just answer a few simple questions to see plans and prices in your area. You will still need to complete the application to find out how you can get lower costs, but this is a much enhanced version of earlier information and one more way you can get the information you need to help you get ready to enroll and find a plan that fits your needs and budget.

You can remove problem applications. If you’ve experienced problems filling out your online application, you can start over with a brand new application. To do this, you’ll first need to log in to your account; select your current application; and then choose to “Remove” the application. You will then need to close out your web page and then log back in using your same account. You can then start a brand new application.

Get help enrolling online, on the phone, or in person. You can get help where and when you need it. For example: You can start an application online and then call 1-800-318-2596 (TTY: 1 855-889-4325) 24 hours a day, 7 days a week to get help enrolling over the phone. You can also find in–person help from certified assisters in your area. Just enter your zip code to get started.

You can apply offline and continue your enrollment online. If you submitted a paper application or applied over the phone, you can create a Marketplace account to pull up your eligibility determination and complete your enrollment. To do this, you’ll need your application identification number, and you can contact the call center to get it if you don’t know it.

Direct enrollment in a Marketplace plan. Many insurers are now offering the opportunity for you to enroll directly in a Marketplace plan with that company, whether through the insurance company’s website, an agent or broker, or an online health insurance seller.

These new functionality improvements are in addition to the hardware and software improvements we’ve made over the past eight weeks to improve the consumer experience, increase capacity, and ensure that you can successfully move through the entire enrollment process.

We’ll continue to make improvements to HealthCare.gov in the weeks and months ahead, and we encourage you to come back and explore your new coverage options. You have until December 23 to enroll in health coverage that can start as soon as January 1, 2014, and the Marketplace Open Enrollment period runs until March 31, 2014. Here are some shopping tips to get you started.

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As Washington delays, states move on e-cigarettes

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eBy Jake Grovum
Stateline Staff Writer

Money grab, health concerns, or both? Absent guidance from Washington, states are pressing ahead with their own agendas on electronic cigarettes.

Heading into legislative sessions next year, policymakers, industry representatives, health advocates and tax wonks expect electronic cigarettes — or e-cigarettes for short — to be among the top issues at state capitols.

Legislatures are expected to tackle how to classify, regulate and, perhaps most importantly, tax the relatively new products.

The debates in states come as the federal government considers its own answers to similar questions. The Food and Drug Administration is considering classifying e-cigarettes as “tobacco products,” which would extend its reach and potentially subject e-cigarettes to a host of rules and regulations that apply to tobacco cigarettes.

“States are scrambling to figure out how to deal with this,” Ohio Attorney General Mike DeWine said in an interview. “It’s going to be fought out in 50 states; it’s going to be fought out in one jurisdiction after another.”

DeWine was a lead author of an Oct. 23 letter sent by 40 attorneys general to the FDA pushing for federal rules and for e-cigarettes to be treated as “tobacco products” for regulatory purposes.

So far, Washington hasn’t decided how to proceed with e-cigarettes. A proposed rule, expected to be released for public comment in November, was delayed by the government shutdown and is still pending.

That has left a patchwork of rules, regulations and product definitions across the nation, often at the urging of anti-tobacco advocates. “We think it’s really important that states act,” said Danny McGoldrick, vice president of research at the Campaign for Tobacco-Free Kids.

More than half the states, for example, have banned the sale of e-cigarettes to minors, but others have no restrictions. Currently four states — Utah, North Dakota, Arkansas and New Jersey — have lumped the products in with tobacco under indoor smoking bans, even as research about possible ill-effects from second-hand vapor smoke, if there even are any, remains limited.

Some local governments have taken similar steps on their own, enacting rules for e-cigarettes that sometimes go beyond those in place at the state level.

The intensity of the debate illustrates both the lack of good research on e-cigarettes as well as the money at stake. Often, those considering limits don’t even agree on whether applying tobacco regulations is appropriate, given how different the products are. Like tobacco cigarettes, nicotine levels in the “cartridges” that are loaded into the e-cigarette device can vary widely, complicating efforts to agree on a standard approach to regulation and taxation.

E-cigarettes first appeared about a decade ago, and sales have grown exponentially in recent years. The number of American adults who said they have tried them doubled to one in five in just one year (from 2010 to 2011), according to a Centers for Disease Control survey.

Use among middle and high school students also doubled from 2011 to 2012, according to the CDC, with nearly 1.8 million students saying they’ve used them.

E-Cig Revenue

In an era of revenue-hungry state governments — some still dealing with declining revenue from traditional tobacco taxes and recovering from the Great Recession — taxing e-cigarettes seems likely to get the most attention from state lawmakers in 2014. Questions of advertising limits, health claims and ingredient disclosure will likely remain federal issues.

So far, only Minnesota has put in place a specific state tax policy for e-cigarettes, a decision reached in 2012. The products are subject to a 95 percent tax that functions like a sales tax, tacked onto the wholesale cost of the product.

That generally means they are taxed at a higher rate than traditional cigarettes, which are subject to a $1.29-per-pack levy. The state expects to collect $1.16 billion from all tobacco taxes in the 2014-2015 fiscal year.

For now, most other states apply only a sales tax – if they have one – to e-cigarettes. But at least 30 others are considering e-cigarette taxes of some kind next year.

“I will be watching to see if more proposals like Minnesota are replicated in the states,” said Scott Drenkard of the Tax Foundation, an anti-tax research group, “But I hope they are not.”

What this is is a money grab.

As tax experts see it, there’s little rationale aside from simply raising revenue for taxing e-cigarettes as traditional cigarettes. Tobacco, they say, is taxed because it produces negative health consequences that cost the public. For now, there’s little research that shows similar effects from e-cigarettes.

“There is zero, emphasis on zero, justification for taxing e-cigarettes right now,” said David Brunori of the group Tax Analysts, a nonprofit tax analysis group that provides insight to private firms and government agencies. “What this is is a money grab. It’s a way of trying to find revenue to replace lost tobacco taxes.”

According to the nonpartisan Tax Policy Center, state and local tax revenues have somewhat leveled off in recent years as smoking has declined. Collections grew from $7.7 billion in 1997 to $15.8 billion in 2007, but reached just $17.6 billion in 2011, the most recent year available.

Tobacco companies that don’t produce e-cigarettes have often pushed tax parity so their own products are not at a disadvantage. In Minnesota’s case, the state simply said that under its laws, the tax must apply.

But the most popular argument is deterrence—higher taxes might make the product less attractive and less affordable to young people looking for nicotine.

“It has nothing to do with revenue,” Ohio’s DeWine said. “It has everything to do with discouraging use.”

An Alternative to Tobacco

Discouraging use, however, is exactly the opposite goal lawmakers should have, said Ray Story of the Tobacco Vapor Electronic Cigarette Association. It’s an opinion shared by some outside of the industry as well, especially with regard to those already smoking.

“Cigarettes are sold everywhere in the world, and we want to make sure that the e-cigarette is sold as a less-harmful alternative right there next to it,” Story said.

“We should expand the use, not restrict it,” he added, saying that if e-cigarettes can greatly reduce cigarette use the industry “will have made the greatest impact on humanity ever.”

The contrasting approach reflects two key differences in thinking about e-cigarettes: as a new recreational product similar to tobacco cigarettes, or as a potentially less-unhealthy alternative that could even help smokers quit entirely.

E-cigarette producers themselves are divided. Some welcome traditional cigarette-style regulations to a degree, content to play by similar rules as tobacco producers, especially if it saves them from more onerous limits applied to drug manufacturers, for example. Others argue that even thinking about e-cigarettes through the same frame of reference as tobacco is a flawed approach.

Federal officials in Washington will likely be the ones to eventually settle the dispute, and that decision could still be months away. Meanwhile, debates in the states over two key issues within their control – taxes and sales to minors – are likely to rage in 2014.

But the eventual decision from the FDA is sure to affect those debates. “If the FDA says these are essentially tobacco products,” said Brunori of Tax Analysts, “that will give all kinds of cover to state politicians.”

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Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

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Women’s health – Week 15: Depression and Anxiety

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Office of Research on Women’s Health

Everyone feels sad sometimes, but these feelings usually pass within a couple of days. But when a woman has a depressive disorder, it can interfere with daily life and cause pain for her and those who care about her. The good news is that the vast majority of people, even those with the most severe depression, can get better with treatment.

Your health care provider may conduct a complete medical and psychological evaluation and will recommend an appropriate treatment. The most proven treatment methods are certain antidepressant medications and kinds of psychotherapy.

Women with depressive illnesses may not all experience the same symptoms. The severity, frequency, and duration of symptoms will vary depending on the person and her particular illness.

The most common symptoms of depression can include:

  • Persistent sad, anxious, or “empty” feelings.
  • Feelings of hopelessness and/or pessimism (belief that things will not get better).
  • Loss of interest in activities or hobbies once pleasurable, including sex.
  • Insomnia, waking up during the night, or excessive sleeping.
  • Fatigue and decreased energy.
  • Irritability, restlessness, or anxiety.
  • Feelings of guilt, worthlessness, and/or helplessness.
  • Thoughts of suicide, suicide attempts.
Antidepressant medication and pregnancy and breastfeeding
Women can be depressed while pregnant, especially if they have a history of depression. Women also can develop depression during pregnancy and especially after giving birth. The decisions about how to treat depression during pregnancy are complex and should be made in consultation with your health care provider before becoming pregnant to develop the best treatment plan.Antidepressants are excreted in breast milk, usually in very small amounts. Health care providers have not noticed many problems among infants nursing from mothers who are taking antidepressants, but research into possible side effects is ongoing. Whether you are planning to get pregnant, or are now pregnant or breastfeeding, consult your health care provider about the risks and benefits to you and your baby when deciding whether to take an antidepressant during pregnancy or while breastfeeding.

Anxiety disorders

People with anxiety disorders feel extremely fearful and unsure. Most people feel anxious about something for a short time now and again. For people with anxiety disorders, the anxiety is so frequent and intense that it seriously disrupts daily activity and quality of life.

Examples of anxiety disorders include:

  • Panic disorder.
  • Obsessive-compulsive disorder (OCD).
  • Post-traumatic stress disorder (PTSD) (see Week 38 for more information).
  • Social phobia (or social anxiety disorder).
  • Specific phobias.
  • Generalized anxiety disorder (GAD).

Each anxiety disorder has different symptoms, but all the symptoms cluster around excessive, irrational fear and dread. There is help for people with anxiety disorders. The first step is to talk to your health care provider about your symptoms. Your health care provider will examine you to make sure that another physical problem is not causing the symptoms. He or she may refer you to a mental health specialist.

Health care providers may prescribe medication to help relieve your anxiety disorder, but it is important to know that some of these medicines may take a few weeks to start working. The kinds of medicines that have been found to be helpful for anxiety disorders include antidepressants, anti-anxiety medicines, and beta blockers.Many people get relief from their anxiety with certain kinds of psychotherapy. These treatments can help people feel less anxious and fearful. You may be referred to a social worker, psychologist, psychiatric nurse, or psychiatrist for psychotherapy.

For more information: www.nimh.nih.gov
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Manage your mantra

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FoodDo you feel that junk food is a forbidden, guilty pleasure?

Would you still be tempted if you thought of it as fat-laden, overly processed, or disease-promoting?

Perhaps if we thought of whole foods as nutritious and tasty – rather than “healthy” or “weird” – we would be inclined to eat more of them.

The psychology surrounding food can have a huge sway on our preferences!

Reconsider your food beliefs this week.

Instead of thinking “that’s pretty good… for a healthy food” enjoy the flavors and think about the nutrients you’re are getting.

Instead of saying “I can’t try that…” have at least one bite!

 

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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In Kansas, a fight over developmentally disabled shifting to Medicaid managed care

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Neil Carney, 18, who is autistic and mentally retarded, enjoys a swing in the backyard of a house where he lives with a professional caregiver (Photo by Jenni Bergal).

By Jenni Bergal
This KHN story was produced in collaboration with wapo

WICHITA, Kan. — Aldona and Pat Carney call their son, Neil, “a 24-7 kid.” He’s profoundly autistic, severely mentally retarded and attends a special school.

He has tried to eat light bulbs and charcoal briquettes and can be aggressive, sometimes scratching people near him.

Neil, 18, who walks with a limp and carries around a grey sock that calms him, lives in a beige single-family home with a professional caregiver who’s known him for years. The house is equipped with cameras to track his movements and a backyard swing he loves to ride.

Come January, the Carneys – and thousands of parents and relatives of developmentally disabled Kansans – fear that the world their loved ones have become accustomed to may turn topsy-turvy.

That’s when Kansas’ Medicaid managed care system – called KanCare — will take charge of all home and community-based services for about 8,500 developmentally disabled people, most of them adults.

What concerns families and advocates the most is that the three for-profit national insurance companies that run KanCare will be responsible for a statewide program that they’ve never managed in Kansas or elsewhere.

They’re also worried that the need to make a profit ultimately will destroy a system families and advocates think works well.

While Kansas will become the first state to make such a leap, it is being watched closely elsewhere, as at least two other states – Louisiana and New Hampshire – are considering moving in the same direction.

“This is an unprecedented model. No state has ever taken a developmental disability population and placed it in an arrangement like this, with an out-of-state managed care system, all at once,” said Rocky Nichols, executive director of the Disability Rights Center of Kansas, a legal advocacy group. “It’s almost like throwing everyone into the deep end of the pool.”

Aldona Carney said her family and others are “extremely concerned” because these services, such as in-home care and daytime activities, affect people’s day-to-day lives.

“This type of model has not been done in any other state,” Carney said. “We’re worried that the managed care companies don’t have a clue about what it takes to keep developmentally disabled people healthy and safe in their home.”

Kansas officials have assured parents and advocates that services will remain unchanged and that payment rates to agencies that provide care won’t be cut. But many are skeptical.

They fear that the managed care companies will seek to boost profits by reducing services or driving some small providers out of business because of payment delays or denials. The companies say these concerns are unfounded and insist that services will be maintained and providers paid promptly.

Many states are scrambling to place large numbers of people on Medicaid – the state-federal program for the poor and disabled – into managed care in hopes of cutting costs and improving quality.

Nearly 30 million Americans on Medicaid are in private managed care plans and millions more will become eligible for Medicaid in January under the federal health law. Many will be placed in managed care.

Disabled often need extensive care

By next year, more than two dozen states are expected to have set up programs to transfer frail elderly, mentally ill or physically disabled people into managed care for home and community-based services.

But in most states, the developmentally disabled – people with impairments such as cerebral palsy, Down syndrome and autism – have been excluded from managed care for these services because their needs are so specialized.

They live with their families or in apartments, single-family homes or group homes. Some need round-the-clock supervision and many require assistance with dressing, bathing and preparing meals, as well as transportation. Some need help finding a job or volunteer work, and many attend daytime activity centers.

In Kansas, where a network of community-based nonprofit organizations and county agencies oversee these services, individuals can choose a case manager, who visits them at home and coordinates their care. In some cases, those relationships go back decades.

While these organizations will continue to determine what services clients are eligible for and case managers will work with families to arrange that care, ultimately the health plans will be responsible.

“There is a great deal of fear in the community that these big private health plans don’t know much about this population,” said Maureen Fitzgerald, disability rights director for The Arc, a national advocacy organization for the developmentally disabled. “These are such vulnerable people. Mistakes that are just inconvenient to some can be devastating to them. If the home care person doesn’t show up, you could be lying in your bed all day. It’s kind of scary.”

Only a handful of states, including Michigan and Vermont, have moved the developmentally disabled into managed care for long-term services. They’ve mostly relied on existing networks of community-based nonprofits or county agencies or have made themselves the managed care organization. None has turned exclusively to national managed care companies.

But that’s exactly what Kansas Gov. Sam Brownback had in mind when his administration decided to transfer virtually all of the nearly 380,000 people on Medicaid into KanCare, starting in January 2013.

Kansas contracts with three companies — Amerigroup, UnitedHealthcare Community Plan and Sunflower State Health Plan, a subsidiary of Centene. It gives them a fixed amount per member each month. As of Sept. 30, it had paid them a total of $1.3 billion for this year.

The companies provide medical, pharmaceutical and mental health care to KanCare members, including the developmentally disabled.

Brownback, a Republican, has said that KanCare will improve care coordination and reduce growth in Medicaid spending for the state and federal government by $1 billion over five years.

Although the frail elderly, physically disabled and mentally ill are now getting long-term services through KanCare, inclusion of the developmentally disabled was delayed until 2014 by the legislature following bitter protests from parents, advocates and providers.

Lawmakers wouldn’t yield again, even as more than 1,000 people rallied outside the Capitol in Topeka in May, many wearing red T-shirts that read: “Not Worth the Gamble.”

Kansas State Rep. Nancy Lusk, a Democrat from Overland Park, said she received so many “passionate e-mails” opposing the state’s plan that she put together a video highlighting the stories of families who would be affected, posted it online and sent a message to her colleagues.

Shawn Sullivan, Secretary of the Kansas Department for Aging and Disability Services, said in an interview that providers who are fearful of change had gotten families riled up unnecessarily.

He said families and advocates need not be worried because clients will be able to keep their case managers and agencies that provide services won’t have reimbursements slashed.

The major difference, Sullivan said, is that the insurance companies will hire care coordinators who will work in conjunction with case managers and providers.

Sullivan, a former nursing home administrator, conceded that state officials should have done a better job interacting with families and providers from the start.

“I think there are a lot of lessons learned,” he said. “I would have gone and worked with families and guardians and all the providers to address their concerns and do a better job of communicating the protections we have in the system.”

Sullivan said the upcoming changes, which still have to be approved by federal health officials, won’t produce cost savings initially. But they will improve outcomes for clients who will receive more employment opportunities and better coordination of their medical and mental health care, he said. Ultimately, that will save money because of fewer hospitalizations and medical costs.

Companies say they won’t cut services

Kansas currently spends about $349 million a year on home and community-based care for the developmentally disabled— about 10 percent of its Medicaid budget. A

study by the University of Minnesota’s Institute on Community Integration found that Kansas paid on average $40,464 a person in fiscal 2011, which was mid-range in national rankings.

Jean Rumbaugh, president of Sunflower State Health Plan, said money can be saved by reducing inefficient care and better coordinating services. We want to provide solutions to states and have a holistic approach to this population,” she said. “It is a new opportunity and one that I think Centene is very interested in.”

Rumbaugh said Sunflower’s goals – which are similar to the other two plans’ — are to support families, meet individuals’ needs, focus on competitive employment and make sure clients have access to medical and mental health care.

Amerigroup Kansas President Laura Hopkins said her plan wants to protect the array of services for clients. “There’s no incentive for us to cut services, from a contract perspective or from a human perspective,” she said.

Debra Lipson, a senior researcher for Mathematica Policy Research, a nonpartisan think tank, cautioned that Kansas’ blueprint presents “huge challenges.”

“They’re entering into virgin territory,” she said. “They don’t have a lot of models to follow, and it’s a highly vulnerable population, and therefore you can’t skimp on oversight. And there’s a risk when you’ve got national companies that don’t bring a tremendous amount of experience in this area.”

The health plans say that while they may not have much experience with this particular type of program, they have been handling similar services for physically disabled and elderly members. They also have been hiring workers and managers with expertise in developmental disabilities in Kansas.

Kansas official Sullivan dismissed criticism about the companies’ lack of experience, noting that the state will maintain a high level of oversight and stringent contractual requirements, such as withholding 3 to 5 percent of payments to the plans to ensure performance requirements are met.

But some family members say they’re not optimistic because they’ve already experienced problems with KanCare on the medical side.

Kay Soltz, of Wichita, said her 32-year-old son, Zachary, was initially assigned to a pediatrician as his primary care doctor when KanCare launched. After she complained, the health plan assigned him to a doctor located 20 miles away, and Soltz said she jumped through more hoops to get it changed.

Zachary, who is in constant motion, is autistic and mentally retarded. He spends much of his time watching 30-second snippets of old TV game shows from his childhood and listening to TV theme songs on his Walkman over and over. He attends a day program and, like Neil Carney, lives in a single-family home with a caregiver.

Soltz, 63, said she has “no confidence” in the health plans taking over management of long-term care for Zachary.

“At my age, I’d like to think my son has something stable, something that will protect him if I’m not here,” she said. “Boy, I don’t feel that way at all.”

In recent months, KanCare has also come under attack from hospitals and some providers, who have charged that the health plans have improperly denied or delayed reimbursements and created serious financial and bureaucratic obstacles for them.

The companies say they have been meeting with providers to work out the bugs and have been trying to resolve any systemic problems on their end. But they note that providers also need to become more familiar with the billing and claims process.

Many long-term services agencies for the developmentally disabled fear the same thing will happen to them in 2014 – and that some smaller providers and mom-and-pop operations won’t be able to stay in business if they can’t pay their bills. They say this would leave clients with fewer choices and could result in them losing their case managers and caregivers.

“It’s very personal and intimate direct care – and home care workers are not paid very much. For small providers, if they don’t get paid, they don’t stay,” said Tom Laing, executive director of InterHab, an association of Kansas providers. “The system was running very well, and now it will be operating on flat tires and worn-out spark plugs.”

In Hutchinson, Ginger Zyskowski worries that the nonprofit agency that cares for her brother, Kyle Hulet, could suffer financial instability under KanCare if the health plans don’t pay on time and in full.

Kyle Hulet, 63, with his sister Ginger Zyskowski at his apartment (Photo by Jenni Bergal).

Kyle Hulet, 63, with his sister Ginger Zyskowski at his apartment (Photo by Jenni Bergal).

Hulet, a cheerful 63-year-old quadriplegic with cerebral palsy who loves watching wrestling and singing at church, lives in an apartment. He works next door at the agency’s front desk, earning about $29 a week for four hours’ work, answering phones in tandem with another client. He also uses a computer to type up banners and notices by pushing a button with his head.

“Right now, my brother is in a pretty safe place. I’m not sure what the future’s going to hold,” said Zyskowski, 67. “There is a fear among older caretakers like me that if this thing with KanCare goes wrong, what’s going to happen? He could outlive me, and what’s in place for him?”

Aldona and Pat Carney share similar thoughts about their son, Neil. He lived with them for years, but it no longer was safe for him – or them — in his family home.

He didn’t do well in a group home, so, with the help of two of Pat’s brothers, they purchased and renovated the house he now lives in with his caregiver, who teaches him about tasks such as brushing his teeth and dressing himself. ]

Aldona Carney said the state pays a nonprofit agency about $71,000 a year for his residential services – the maximum rate because of his extreme disabilities, which is cheaper than if he were institutionalized.

Carney, 51, said she envisions the house as a place for Neil to live the rest of his life. But she fears that at some point with KanCare, that could change because of the cost.

“There’s a definite lack of trust among parents and families in this state,” she said. “We had a system that worked really well, so why are they trying to fix something that’s not broken?”

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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Twitter chat on pregnancy and childbirth with Group Health’s Dr. Jane Dimer, Tuesday, December 10

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hashtagJane Dimer, MD – an OB/GYN and chief of Women’s Services for Group Health – on Tuesday, Dec. 10 from 12-1 pm for an hour-long Twitter chat on pregnancy and childbirth. Dr. Dimer will be covering a variety of topics from getting pregnant to delivery, and answering your questions.

Topics will include:

  • Preparing your body for pregnancy
  • Nutrition
  • Is this normal?
  • Pregnancy myths
  • Making a birth plan
  • Delivery
  • Back to work/breastfeeding

When: Tuesday, Dec. 10 from 12-1 pm

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Does knowing medical prices save money? California experiment says yes

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Hip replacement  - thumbBy Ankita Rao

The fact that the cost of a hip replacement can ring up as $15,000 or $100,000 — depending on the hospital — makes a lot of people uncomfortable. But that’s only if they know about the wide price tag variations.

In an effort to raise awareness and rein in what can seem like the Wild West of health care, the California Public Employees’ Retirement System (CalPERS), the second largest benefits program in the country, and Anthem Blue Cross started a “reference pricing” initiative in 2011.

The initiative involved a system to guide their enrollees to choose facilities where routine hip and knee replacement procedures cost less than $30,000.

Here’s how it works: The CalPERS program designated certain hospitals that met this cost threshold, and enrollees who chose among these facilities pay only the plan’s typical deductible and coinsurance up to the out-of-pocket maximum.

Patients who opted for other in-network hospitals were responsible for regular cost sharing and “all allowed amounts exceeding the $30,000 threshold, which are not subject to an out-of-pocket maximum,” noted the report.

The results tallied savings of $2.8 million for CalPERS, and $300,000 in patients’ cost sharing, according to research released Thursday by the Center for Studying Health System Change for the non-profit group National Institute for Health Care Reform.

Researchers found that patients who received “intensive communication” from CalPERS were supportive of the efforts and recognized lack of price transparency in the system. The report also said enrollees were satisfied with the level of care they received when choosing facilities that met their cost threshold.

But that information has yet to reach the larger population of health consumers, said Alwyn Casill, the director of public relations for the Center for Studying Health System Change.

“There is a tremendous need to increase public awareness of this problem,” she said. “It should matter to you as someone who is paying for health care, not just for you, but for everybody.”

While the report doesn’t completely detail CalPERS’ approach to reference pricing, Casill said there is optimism that it will be a model for other insurance plans and medical systems.

But that is further limited by the narrow focus of this initiative on just two kinds of procedures — others, like MRIs and CAT scans, are also vulnerable to wide pricing disparities.

Some experts say any real success on streamlining health care costs will include the ability for consumers to understand the issue and call for change.

“The numbers are dramatic,” said Julie Schoenman, director of research and quality at the National Institute For Health Care Management Foundation, a non-profit educational organization unaffiliated with the report. “I think you really do need to have good quality measures, good transparency. And a lot of patient education.”

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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What happens if my income changes after I receive an insurance subsidy?

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Question markBy Michelle Andrews

Q. If I’m unemployed at the beginning of the year and sign up for health insurance through my state’s health insurance exchange, I’d probably get a subsidy because my income would be low. But what happens if I get a job later in the year and start earning a good salary? Will I have to pay the money back? 

A. You may have to repay some of the money, but the amount you’d owe would likely be capped. Every individual’s circumstances are different, but here’s how it might work in a typical situation.

When you apply for health insurance on your state’s marketplace, you’ll be asked about your income. Ifyou’re collecting a typical unemployment check of about $300 a week and you live in the District of Columbia or one of the 25 states expanding Medicaid to adults with incomes up to 138 percent of the federal poverty level ($15,856 for an individual in 2013), you’ll probably qualify for coverage under that program and won’t have to buy a plan on the exchange.

If you live in a state that’s not expanding Medicaid, however, you can shop for subsidized coverage on your state’s marketplace. Premium tax credits are available to individuals with incomes between 100 and 400 percent of the federal poverty level ($11,490 to $45,960 for an individual in 2013).

If you’re collecting $300 a week in unemployment benefits, you’d probably qualify for a premium credit. If you choose to receive the credit up front rather than at tax time next year, your insurance premium would be reduced by the amount of your tax credit, and the government would send that amount to the insurer.

Let’s say you land a job in July with a $60,000 annual salary, but it doesn’t offer health insurance. At that point, you’d need to inform the marketplace about your change in circumstance.

“The key is to reach out immediately when things change,” says Brian Haile, senior vice president for tax policy at Jackson Hewitt Tax Service.

At your new salary, you’d no longer qualify for a premium tax credit, and you’d have to pay the full premium. At tax time, the government will reconcile the amount that you received in tax credits against your income for the year, in our example, roughly $38,000, including six months of salary and six months of unemployment insurance.

If the amount you received in tax credits is higher than it should have been based on your annual income, you’ll have to pay back the difference. But under the law your liability is limited if your income is less than 400 percent of the federal poverty level. Someone like you with income between 300 and 400 percent of poverty ($34,470 to $45,960 in 2013) would be liable to repay no more than $1,250.

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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“Multiple Sclerosis in the Pacific Northwest” – Science Cafe, Monday, Dec. 9

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Illustration of the skull and brain“Multiple Sclerosis in the Pacific Northwest”
Monday, December 9, 2013 – 7 p.m. – Wilde Rover

Multiple sclerosis is a mysterious disease that is particularly common here in the Pacific Northwest. At the December Eastside Science Café, join the Swedish Neuroscience Institute’s James Bowen, M.D., to discover more about MS as a disease, trends and changes in its distribution around the world, and how it uniquely impacts our region.

Wilde Rover is located in downtown Kirkland at 111 Central Way.

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When temperatures dip, air quality often does as well

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Illustration of the lungs in blueFrom the Washington State Department of Health

You may have noticed spectacular evening skies this winter, yet those sunsets frequently are a sign of air quality problems that occur this time of year. Winter weather patterns can trap air pollution – especially from wood stoves and fireplaces – near the ground, where it can build-up and may threaten people’s health.

The state Department of Health is reminding people air pollution can be harmful to their health. It can be especially harmful for people who have a lung condition like asthma, chronic obstructive pulmonary disorder (COPD), or with heart disease.

Air pollution has fine particles that can cause immediate and long-term health effects when inhaled. It’s a good idea to check local air conditions and limit outdoor activities when air quality conditions are poor.

The amount of air pollution that causes immediate health problems varies from person-to-person. For people who are sensitive to air pollution, even a short outdoor stroll can cause wheezing or shortness of breath.

Others may not have problems until they do more strenuous activities like yard work, running, or shoveling snow. Kids and adults over 65 are among those who should limit their activity during periods of poor air quality.

Air pollution often can’t be seen or smelled, but the state Department of Ecology monitors air conditions and posts them online across the state. More information and statistics on air quality in your community can be found on our website.

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Medicaid expansion to cover many former prisoners

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ACA health reform logoBy Guy Gugliotta
This KHN story was produced in collaboration with wapo

ADRIAN, Mich.—When Medicaid expands next year under the federal health law to include all adults living close to the poverty line, one group of eligible beneficiaries will be several million men and women who have spent time in state and federal prisons and jails.

The Department of Justice estimates former inmates and detainees will comprise about 35 percent of the people who will qualify for Medicaid coverage in the states expanding their programs to anyone earning less than 138 percent of the federal poverty level, or about $15,000 for an individual in 2013.

The Congressional Budget Office estimated earlier this year  that 9 million people will get that new coverage next year.

In addition, the expansion could help states cover the medical costs of some current inmates who need hospitalization or other expensive specialized care outside of prison.

Michigan, which has long been recognized as an innovator in inmate health care, is expanding its Medicaid program.  Officials here say that funding could help cover the needs of some seriously ill inmates as well as provide new coverage for released offenders, which could be a valuable tool in curbing recidivism.

“A significant number have never prepared their own meals. They don’t know how to shop, or how to budget,” said Tammy Meek, prisoner re-entry coordinator for the Gus Harrison Correctional Facility in this small city in southern Michigan. “Some can’t even write their name in cursive. Health care is critical in protecting the public and giving the client [former inmate] the tools he needs to succeed.”

GOP Lawmakers’ Concerns

But the Medicaid coverage for former offenders has stoked the interest of some powerful GOP members of Congress, including one from Michigan, House Energy and Commerce Committee Chairman Fred Upton.

He and Health Subcommittee Chairman Joe Pitts of Pennsylvania last month asked the Government Accountability Office to review the effect of the health law’s Medicaid provisions on former offenders.

“We  must better understand the true costs of expanding the program to any new population and weigh such costs with the competing interests of our nation’s most vulnerable law-abiding citizens,” they wrote.

A Republican committee source said Upton and Pitts simply wanted “updated data” from GAO on “how Medicaid interacts with the criminal justice system” because they were “committed to understanding how every Medicaid dollar” will be spent under the new health law.

A Democratic committee source, however, dismissed the Upton initiative as “a complete red herring” prompted by Republicans’ search “for another way to come up with something that will ding the Affordable Care Act.”

The congressmen’s request notes that some researchers have suggested that large numbers of people added to the Medicaid rolls in an expansion could be prisoners. But ordinary, in-prison health care is not covered by Medicaid.

The Medicaid law, passed in 1965, denies federal matching funds for convicted prisoners—about 1.5 million adults nationwide—and for 750,000 unconvicted detainees held for trial or petty crimes and misdemeanors in county and city jails on any given day.

Each state, county or city must pay for the medical needs of all detainees from its general funds. The Affordable Care Act does not change this law.

However, since 1997, the federal government has allowed matching Medicaid funds to pay for specialized hospital care for 24 hours or more outside the prison system for inmates who were enrolled in or eligible for Medicaid before their incarcerations.

Since most states narrowly draw the eligibility rules for adults, this funding generally covered people such as the frail elderly, patients suffering from serious disabilities and chronic diseases and pregnant women.

Michigan received $8 million in matching funds for that program during the year ending Sept. 30, state Department of Corrections spokesman Russ Marlan said. Next year, when about half the states have agreed to expand their Medicaid programs, the number of these patients should rise dramatically as will the federal matching funds.

Marlan said Michigan could receive $20 million in Medicaid funding from the federal government in 2014 to help pay for such specialized treatment of prisoners, “but it’s probably too early to know for sure.”

Potentially far more important for the state’s bottom line, Medicaid expansion will also cover low-income inmates leaving prison.

“Having access to health care and mental health care contributes to their success in staying out of prison,” noted Heidi E. Washington, warden at the Charles E. Egeler correction facility in Jackson, Mich.

Lowering Recidivism

Helping former inmates adjust to the outside world has been shown in many studies to curb recidivism. Michigan, which has used state funds for reentry programs that include health care for nearly a decade, has seen its prison population drop in the past five years from 51,554 to 43,636.

For released offenders with special needs—mostly mental disorders—recidivism rates plummeted from 50 percent in 1998 to 22.5 percent in 2012. Michigan spends $35,000 each year for every imprisoned inmate.

But curbing recidivism doesn’t just hinge on having funding from programs like Medicaid, noted Ira Burnim, legal director of the Bazelon Center for Mental Health Law. “These folks have to have services, and when they have access to housing and local support, they do very, very well.”

Michigan in 2005 hired a private company, Professional Consulting Services, to coordinate individual release plans for special needs inmates, serving as an intermediary between the Department of Corrections, state Medicaid officials and outside housing and service providers.

Chief Operating Officer Betsy Hardwick said PCS handles about 1,200 cases at any one time, preparing individual support plans and monitoring inmates for their first nine months on the outside.

Hardwick said that 28 percent of the special needs inmates had Medicaid on release, but by the end of their first year in the community, “anecdotally we think between 60 percent and 70 percent are being approved.”

The effort appears to be a critical confidence builder for Martin Baker, 61, a repeat offender for breaking and entering who earlier this month was getting ready for parole at Adrian’s Gus Harrison prison and had been notified that he will have Medicaid upon release.

“I’ve got a bad liver from hepatitis C, and I couldn’t afford any medications on my own,” said Baker, a small but fit gray-haired man who also suffers from bipolar disorder and battled drug issues in the past. “My primary goal is to get my medical situation stabilized and get into a solid recovery program.”

Without insurance, he said, “you feel sick, and it causes you to get depressed and not care, so you say, ‘okay, I’m going out and get a pack of heroin.’ I don’t want that to happen.

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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What’s the deadline for signing up for health insurance?

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clockBy Keith Seinfeld
Public Health – Seattle & King County

If you’ve only been paying half-attention to all the news about health insurance and the Obama Administration’s updates to the new insurance rules — you might be uncertain about the deadline for signing up.

In truth, there are two deadlines. Which one matters? It depends on your circumstances.

Deadline #1 – Dec. 23rd:

December 23rd, the first deadline — matters if you absolutely want or need insurance benefits starting on Jan. 1st.

If you meet this deadline, you can visit a doctor or hospital the first week of January, with your insurance benefits (assuming you can find a doctor with open appointments).

You might be someone who currently has an insurance plan that’s ending, and you don’t want to risk a break in coverage (imagine going one month without insurance, and that’s the month you fall off a ladder).

Or, you might be someone who’s been uninsured for years and waiting for the opportunity to buy affordable insurance. I

f you sign-up (and pay your first-month’s fee) by Dec. 23, then you’ll have insurance you can use starting the first of January.

Deadline #2 — Mar. 31st:

March 31st — the second deadline — matters if you want insurance before the federal tax penalty kicks in, and you want to get some benefits during the 2014 calendar year. Anyone who enrolls by Mar. 31 will avoid the tax penalty that comes with the federal mandate to have health insurance for 2014.

Other options? Yes

During January, February and March, you can enroll at any time. Your benefits will begin the following month, if you’ve enrolled by the 23rd of the month. So, for example, if you enroll on Feb. 20, you’re insurance benefits would begin on Mar. 1.

Note to anyone waiting for the last week of March: Enroll by Mar. 23 to have coverage in April.

Everyone who enrolls from Mar. 24-31 will have to wait until May 1st for those benefits to kick in.

The trade-offs: Now vs. later

The benefit of enrolling sooner is clear — you’ll have insurance protection as soon as possible, and there’s good evidence that people with health insurance are able to live healthier lives, while also protecting against financial ruin caused by huge medical bills.

But, if you’re confused about your choices, and worry about picking a plan that you’ll regret later, then it might make sense to take your time. If you can get personal assistance through the toll-free help-line (855-923-4633), or through an In-Person Assister, that helps. But if you’re having trouble connecting this month, there’s still time early next year.

Either way, if you need to buy your own insurance, the enrollment team at Public Health – Seattle & King County suggests it’s a good idea to start looking at Washington Healthplanfinder, create a personal account, try browsing the options, and compile a list of questions.

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Group Health and Bartell Drugs to open retail clinics

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Group Health IconGroup Health Cooperative and Bartell Drugs will open three retail clinics early next year in Ballard and University Village in Seattle and at Crossroads, Bellevue.

The “CareClinics” will be staffed by nurse practitioners from Group Health and provide walk-in service to the general public for common minor illnesses and procedures, such as cold and flu, sinus infections, allergies, minor injuries (burns, rashes, and cuts), pinkeye, sore throat, headaches, sprains and strains, bronchitis, ear infections, urinary tract infections, and diarrhea.

Care will be provided for adults and children over two years of age. Patients will not have to be Group Health members to receive care

The clinics are slated to open between mid-January and early March.

The initial locations will be:

  • Ballard – 1500 NW Market St, Suite 101, Seattle, WA  98107-5211
  • Crossroads – 653 156th Ave NE, Bellevue, WA 98007
  • University Village – 2700 NE University Village St., Seattle, WA 98105

 

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