Thursday, March 28, 2013

Law Says Insurers Should Pay For Breast Pumps, But Which Ones?

More From Shots - Health News Health'Sponge' Drug Shows Promise For Treating Hepatitis CHealthCatalog Of Gene Markers For Some Cancers Doubles In SizeHealthAllergy Drops Under The Tongue May Be Fine Alternative To ShotsHealth CareEmployers Try To Spur Healthy Behaviors With Health Plan Rewards

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Saturday, March 23, 2013

Health Insurers Warn on Premiums

From the Wall St. Journal –

Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation’s biggest firm projecting that rates could more than double for some consumers buying their own plans.

The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year�a subject of rigorous debate.

The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human Services says that the law will “make health-care coverage more affordable and accessible,” pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower.

The gulf between the pricing talk from some insurers and the government projections suggests how complicated the law’s effects will be. Carriers will be filing proposed prices with regulators over the next few months.

Part of the murkiness stems from the role of government subsidies. Federal subsidies under the health law will help lower-income consumers defray costs, but they are generally not included in insurers’ premium projections. Many consumers will be getting more generous plans because of new requirements in the law. The effects of the law will vary widely, and insurers and other analysts agree that some consumers and small businesses will likely see premiums go down.

Starting next year, the law will block insurers from refusing to sell coverage or setting premiums based on people’s health histories, and will reduce their ability to set rates based on age. That can raise coverage prices for younger, healthier consumers, while reining them in for older, sicker ones. The rules can also affect small businesses, which sometimes pay premiums tied to employees’ health status and claims history.

Continue reading…

Friday, March 22, 2013

Colorado Doctors Treating Gunshot Victims Differ On Gun Politics

More From Shots - Health News HealthDoubts Raised About Cutting Medicare Pay In High-Spending AreasHealthTalk Globally, Go Locally: Cellphones Vs. Clean ToiletsHealthHow A Sleep Disorder Might Point To A Forgotten FutureHealthTuberculosis Cases In The U.S. Keep Sliding

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Wednesday, March 20, 2013

Law Says Insurers Should Pay For Breast Pumps, But Which Ones?

More From Shots - Health News HealthHow A Patient's Suicide Changed A Doctor's Approach To GunsHealthAs Health Law Turns Three, Public Is As Confused As EverHealthHow Ideas To Cut ER Expenses Could BackfireHealthLaw Says Insurers Should Pay For Breast Pumps, But Which Ones?

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How Ideas To Cut ER Expenses Could Backfire

More From Shots - Health News HealthHow Ideas To Cut ER Expenses Could BackfireHealthLaw Says Insurers Should Pay For Breast Pumps, But Which Ones?HealthSorting Out The Mammogram Debate: Who Should Get Screened When?HealthThe Doctor Will See You And A Dozen Strangers Now

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Tuesday, March 19, 2013

Affordable Care Act at 3: Abby’s Story

I remember the day the health care law passed three years ago. The law made history as one of the most significant pieces of health related legislation since the passage of Medicare and Medicaid. On a personal level, it fundamentally changed the course of my life. At the time, I was 20 years old, a college student, and facing the reality that I would be kicked off my parents� high-quality private insurance, on my twenty-first birthday. I would have limited, if any, options for health insurance and it put me face to face with my own mortality.

I was born with a serious, rare disease. Without high-quality health care, or health insurance, I would suffer potentially fatal consequences. Most children who are born with my disease, toxoplasmosis, have profound side-effects that can include organ failure, blindness, and intellectual disabilities. Throughout my childhood, I was fairly healthy. But during high school I began to face the realities of what it meant to have this disease. I had neurosurgery to replace the 16-year-old shunt that was installed to drain spinal fluid collecting on my brain, and I lost vision in my left eye when the parasite attacked my eyes. Since then, I have struggled to remain healthy and have had several shunt replacements and eye surgeries.

Knowing how stressful, painful, and scary these experiences were with health insurance, as I got older, my family and I went into a panic. We knew I would no longer be eligible for their insurance, and we knew beyond a shadow of a doubt that I would be denied coverage due to my multiple pre-existing conditions. This was where we were in March 2010.

But everything changed three years ago, when President Obama signed the Affordable Care Act.

Over the last three years, my fear has disappeared and has been replaced with a profound sense of hope and empowerment.� Now, I can stay on my parents� plan until I turn 26. As a 22-year-old college graduate with multiple pre-existing conditions, I could not be more grateful. Moreover, now there are no more lifetime limits on how much my insurance company will pay for my essential health benefits � and annual limits are ending, too. And in 2014, the health care law helps to ensure that I cannot be denied coverage due to my chronic illness.

However, there is greater hope beyond what I am experiencing personally. The governors of many states are getting behind expansion of Medicaid coverage for Americans who may find it difficult to afford private insurance. �The states and the federal government also are creating a Health Insurance Marketplace for each state, where people can compare health plans based on price and benefits and purchase the one that best fits their needs. Open enrollment starts Oct. 1, 2013, with coverage beginning as soon as January 2014.

I am eager to see what the coming years will bring. The Affordable Care Act is still a new law, and there is certainly more work to be done. It will not happen overnight, nor will it be easy. However, in just three years, we are already well on our way to building a more equitable, effective, and high-quality system of care. This is not the end; it is merely the beginning.

The U.S. Department of Health and Human Services supports the statements by the guest author of this article.

Saturday, March 16, 2013

Affordable Care Act, Jobs, and Employer-Sponsored Insurance: A Look at the Evidence

Since the Affordable Care Act became law in 2010, health care cost growth has been lower than in the past � and lower than was projected when the law passed almost three years ago.

Private health insurance premium growth per person was slower than overall economic growth in 2011, and a new survey by Towers Watson/National Business Group on Health found that the growth in employers� costs for employee health benefits in 2012 was at its lowest in 15 years.

Also, a recent indepth analysis by USA Today found that, �cost-saving measures under the health care law appear to be keeping medical prices flat.�

But ever since the health care law was debated in Congress, we have seen a lot of misinformation, which often leads to misunderstanding of the law itself and how it benefits consumers and businesses, both large and small.

For example, back in October 2010, the Beige Book from the Federal Reserve reported that some employers anticipated increased costs of employee benefits immediately as a result of health care reform, and last week�s Beige Book has been cited by some long-time critics as suggesting jobs are not being created because of employers� uncertainty about how the law will affect them.

However, when assessing the impact on labor markets, there is both analytical and anecdotal evidence that tells the real story. For example, the Congressional Budget Office (CBO) projected that the reduction in labor would be minimal�at roughly half a percent�and would result almost exclusively from employees deciding to retire early or voluntarily work fewer hours.�

There is also a real-life example of how a similar law affected the labor market.� The experience in Massachusetts is consistent with the CBO projections.� Studies found no negative impact on the labor force in the State after it implemented similar reforms in 2006.� In fact, there may have been a shift toward full-time work as workers sought to gain access to their employers� plans to avoid the individual responsibility penalty in the State.

And, last week�s job report suggests that private job growth is strong.� The economy has added private sector jobs for 36 straight months, for a total of nearly 6.4 million jobs during that period.� The service sector � the source of many of the questions about the health care law � led the way in monthly job creation in February.�

In addition, some initial statements made by CEOs about scaling back full-time workers have now been reversed.� For example, the CEOs of chains such as Applebee�s and Papa John�s Pizza have called their earlier statements about reducing hours premature.� The CEO of Darden, owner of chains like the Olive Garden, stated: �As we think about healthcare reform, while many of the Patient Protection and Affordable Care Act�s rules and regulations have yet to be finalized, we are pleased we know enough at this point to make firm and hopefully reassuring commitments to our full-time employees.��

Over time, many provisions of the health care law will work to create a more efficient, higher quality health care system and slow the growth of health care.� This is not just good for the health system, but it is good for American jobs and the economy.�

Friday, March 15, 2013

The State of Latino Health Twitter Chat

Not all Americans have equal access to health care � or similar health care outcomes. Racial and ethnic minorities, and other underserved populations often have higher rates of disease, fewer treatment options, and reduced access to care. This is because many Latinos have less access to health insurance and half of Latinos don�t have a regular doctor. Because of this unequal access to health care, troubling health disparities have emerged.

But the good news is that the health care law, the Affordable Care Act, is the most powerful legislation in decades for reducing health disparities.� A few ways the law will help reduce grave health disparities, is by: expanding preventive care like cancer screenings and immunizations at no additional costs, better coordinating care like home visits for expectant mothers, expanding diversity and cultural competency, ending insurance discrimination so people who have been sick can�t be excluded from coverage or charged higher premiums, and making care more available in underserved communities by investing in our primary care workforce and community health centers.

With this in mind, we want to talk to you about the law�s impact on the Latino community. On Tuesday, February 21st, at 3:00pm EST Mayra Alvarez, Director of Public Health Policy at HHS, will be available on Twitter at @HHSgov to answer questions about how the law helps the Latino community get a fair shot at better care and lower costs. We�ll also be teaming up with National Council of La Raza, National Latina Institute for Reproductive Health, and Families USA. We will be accepting and responding to questions in English and Spanish, depending on what language the question is asked.

You might be wondering:

How does the law protect me?Will the law save me money?What kids of preventive services does the law cover?What are the benefits that are available to me now, and what is coming in future years?

Please submit questions using the hashtag #LatinoHealth. Go to @HHSgov on Twitter to join.

For more information about the benefits of the new health care law, please visit www.healthcare.gov or our Spanish-language site, www.cuidadodesalud.gov

Thursday, March 14, 2013

Cardiac Arrest Survivors Have Better Outlook Than Doctors Think

More From Shots - Health News HealthBinge Drinking Sticks Wisconsin With A Hefty TabHealthAmericans More Distracted Behind The Wheel Than EuropeansHealthCardiac Arrest Survivors Have Better Outlook Than Doctors ThinkHealthNeurologists Warn Against ADHD Drugs To Help Kids Study

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Progress Continues in Setting up Health Insurance Marketplaces

Ten months from today, Americans in every state can begin to choose health insurance in new state marketplaces where they will have access to affordable coverage.� Many will have never had health insurance, or had been forced to make the decision to go without insurance after losing a job or becoming sick.� It is a groundbreaking time for health care in our country.

Today, we�re announcing that six states who applied early have made enough progress setting up their own marketplaces or Exchanges that we are ready to conditionally approve their plans�meaning they are on track to meet all Exchange deadlines.� These early applicant, early approval states include: Colorado, Connecticut, Massachusetts, Maryland, Oregon, and Washington.�

We are excited to be reviewing applications from other states making progress in building their Exchange.� We will make many more announcements like this in the weeks and months to come and expect that the majority of states will play an active role operating their Exchanges.

Some states have requested additional information to help guide their work implementing the health care law.� We value the hard work states are undertaking and to ensure that states have all the information they need to move forward, today we are providing more information that will answer some questions states have been asking.� You can read the letter I sent to Governors here.

This letter follows information we have provided to states in the past month to help them build their Exchanges, expand and improve their Medicaid programs, and make health care coverage more affordable for every American.� It answers frequently asked questions by state officials, summarizing previous guidance and offering new information.�

For example, we explain how Exchanges and Medicaid administrative costs will be funded and how we will continue exploring opportunities to provide States additional support for the administrative costs of eligibility changes.� We clarify in our new guidance that states have the flexibility in Medicaid and the Children�s Health Insurance Program to provide premium assistance for Exchange plans as well as to adopt �bridge plans� that offer coverage through both Medicaid and Exchanges � keeping individuals and families together when they cross the line between Exchanges and Medicaid.� And, while the law does not create an option for enhanced match for a partial or phased-in Medicaid expansion to 133 percent of poverty, we will consider waivers at the regular matching rate now and, in 2017 when the 100 percent federal funding for the expansion group is slightly reduced, broad-based State Innovation Waivers.�

We hope states will take advantage of the substantial resources available to help them insure more of their residents. As an independent report highlighted, �Accounting for factors that reduce costs, states as a whole are likely to see net savings from the Medicaid expansion.�

Today�s approval for these six early states and our continued effort to give states the guidance and tools they need to move forward, ensures that starting in October 2013, consumers in all states can begin filling out applications for private health insurance in affordable, quality plans. ��And our work with states will continue.� If states decide they want to play a larger role in running the new marketplace in their state in 2015, 2016 and beyond, we will work with them so they can have the opportunity to take on that role. �We are excited about the progress we�re announcing today, and we will continue to work side-by-side with states as they implement the critical reforms to our health care system that our citizens need and deserve.���

Wednesday, March 13, 2013

'We Shouldn't Have To Live Like This'

March 13, 2013

Listen to the Story 7 min 47 sec Playlist Download Transcript   Hide caption Linwood Hearne, 64, and his wife, Evelyn, 47, stand near Interstate 83 in Baltimore where they have slept on and off for the past four years. According to the local nonprofit Health Care for the Homeless (HCH), a growing percentage of homeless patients nationally are 50 or older, with complex mental and physical conditions. Previous Next Kainaz Amaria/NPR Hide caption Evelyn displays her bag of prescription medications, which she says are for asthma, chronic obstructive pulmonary disease and depression. HCH offers comprehensive services, including medical care, prescription subsidies, mental health services, housing assistance, and access to education and employment. Previous Next Kainaz Amaria/NPR Hide caption Linwood has long suffered from schizophrenia and admits that he was evicted from public housing after stabbing a neighbor in a fight. Many of the city's chronic homeless have criminal records, which makes it harder to get employment. "I'm getting older, and being out on the streets plays with my mental stability," he says. Previous Next Kainaz Amaria/NPR Hide caption Meredith Johnston, HCH's director of psychiatry, meets with Linwood once a month to review his medications and screen for behavioral symptoms. "Getting into housing will be a huge stabilizing change for Linwood and Evelyn," Johnston says. Previous Next Kainaz Amaria/NPR Hide caption HCH also runs a convalescent floor in a nearby shelter where patients can recover from fractures or recent surgeries. Susan Zator, a community nurse for more than 41 years, bandages 66-year-old William Jones' foot injury. Zator says this service is vital for homeless men and women who cannot recover properly while living on the street. Previous Next Kainaz Amaria/NPR Hide caption Physician assistant Jean Prevas tends to Jones' leg wound. Many aging homeless suffer from ailments not readily visible to outsiders. Medical conditions often go untreated and escalate into more acute health problems. Previous Next Kainaz Amaria/NPR Hide caption Albert Monroe and many others sleep on the porch and under the bright lights of the HCH clinic. Many say it's safer than sleeping under the highway or in city shelters, where theft and violence aren't uncommon. Previous Next Kainaz Amaria/NPR Hide caption Paul Behler, 59, and Tony Simmons, 51, leave a shelter where residents have to be out at 5 a.m. HCH also cultivates potential advocates still struggling to get back on their feet, like Behler and Simmons. Previous Next Kainaz Amaria/NPR Hide caption Behler lost his job as a piano tuner and has been living in shelters for a year and a half. "I'm going to find the way back," he says, "and part of this lobbying effort is making inroads in that respect." The two pass time at a 24-hour Dunkin' Donuts before HCH opens for the day. Previous Next Kainaz Amaria/NPR Hide caption Behler and Simmons take up issues on behalf of the homeless population. Here, they discuss Maryland House Bill 137, which calls for proof of identification at polling places, before going to a hearing in Annapolis. Simmons argues that many homeless have lost their IDs but shouldn't be disenfranchised. Previous Next Kainaz Amaria/NPR Hide caption Simmons irons a dress shirt at his storage unit, which he shares with three other homeless men, in preparation for the hearing. A father of three, he became homeless after a 2011 drug arrest and has been staying in shelters for 14 months. Previous Next Kainaz Amaria/NPR Hide caption Simmons, now clean for more than two years, lost his family and says he's too ashamed to go back home. "I have to find my own way now," he says. "This is my way." Previous Next Kainaz Amaria/NPR Hide caption Simmons hugs Evelyn inside HCH. He has been trying to help the Hearnes and many others get off the streets. Previous Next Kainaz Amaria/NPR

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If aging is not for sissies, that's especially true if you're homeless. You can be on your feet for hours, or forced to sleep in the frigid cold or seriously ill with no place to go. But, increasingly, the nation's homeless population is getting older. By some estimates, more than half of single homeless adults are 47 or older.

And there's growing alarm about what this means � both for the aging homeless and for those who have to foot the bill. The cost to society, especially for health care and social services, could mushroom.

As in many cities across the country, there are plenty of homeless people in Baltimore, Md., � about 4,000 by the latest count. In the early morning hours, dozens of bundled-up men, carrying backpacks and duffle bags, emerge from an unmarked door next to a parking garage downtown.

This is the city's overflow homeless shelter for men, and the residents need to be out by 5 a.m., before office workers start to arrive downtown for the day.

Paul Behler, 59, says he's been homeless for about a year and a half, ever since he lost his job as a concert piano tuner and restorer. Behler says some days he feels like he's 70 years old.

"Haven't got to 80 yet, thank Lord," he laughs. Still, he says he had to go to the hospital emergency room recently because he had a bout of severe tendonitis and couldn't walk without a cane.

The emergency room is a frequent destination for the homeless in every city across the U.S. The list of ailments for those living on the streets is long � blood clots, chronic pain, exposure, diabetes. It's even longer for those in their 50s and 60s, which is considered elderly when you're homeless. The life expectancy is only 64.

On a recent chilly morning, some men head from the Baltimore shelter to their jobs, as cooks or handymen. Others go to the city's day shelter to get warm.

Still others head to a nearby clinic, run by a non-profit group called Health Care for the Homeless, which opens at 7:30 a.m. About a dozen people spent the night outside the clinic sleeping on the concrete steps. It's something of a safe haven.

“ Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach.- Yvonne Jauregui, nursing services coordinator Here, as in similar clinics across the country, a growing percentage of patients are 50 and older. Nursing services coordinator Yvonne Jauregui says many of them are in pretty bad shape by the time they arrive. "Their priority isn't to get preventive care. It's to make sure there's a roof over their head and food in their stomach," she says. Jauregui notes dental care as an example. She says it's not a priority at all. "It's until, 'I can't chew because my tooth hurts so bad and the tooth needs to come out' � that's when we see them," she says. And that makes treatment a lot more difficult. There are other challenges for the homeless. Diabetics have nowhere to refrigerate their insulin. They're not allowed to bring syringes needed for such medication into homeless shelters. Medication is often stolen. And sometimes those with serious foot and leg problems can't get to a doctor. Source: Analysis of U.S. Census data by Dennis P. Culhane Credit: NPR "They are prone to having a lot of foot issues," says Jauregui. "Plus, it's like their primary mode of transportation." Sixty-four-year-old Linwood Hearne is a case in point. He and his wife have been homeless for four years. "I can't balance myself. I can't walk well. I'm getting very forgetful," Hearne says. "I have prostate cancer I have a lot of mental problems that's going on with me. I'm a paranoid schizophrenic. I suffer from manic depression." Dennis Culhane, social policy professor at the University of Pennsylvania, says individuals like Hearne are increasingly common. "We're looking at a group of people who are sort of prematurely reaching old age," says Culhane, who's done extensive research on demographics and homelessness. He says the growth in the aging homeless population is due largely to one group � younger baby boomers � those born between 1955 and 1965. He notes that they came of age in the late '70s and '80s, amid back-to-back recessions and a crack cocaine epidemic. Culhane says individuals in this age group are almost twice as likely as those in other age groups to be homeless. "These are folks who have been living on the margins, in and out of jail, in and out of shelters, in and out of treatment programs for the last thirty, thirty five years," he says. Culhane says people are just coming to grips with what that means. A few communities have started to build special housing for the elderly homeless. Baltimore and other cities are also trying to get those most likely to die on the streets into permanent supportive housing. But funds are limited. Enlarge image i

Health Care for the Homeless is a nonprofit that serves many of Baltimore's aging homeless population. Many sleep in front of the clinic, and others hang out inside to stay warm during the winter.

Kainaz Amaria/NPR

Health Care for the Homeless is a nonprofit that serves many of Baltimore's aging homeless population. Many sleep in front of the clinic, and others hang out inside to stay warm during the winter.

Kainaz Amaria/NPR

Culhane and other experts say it's going to cost a lot more to do nothing. "It's cheaper to have them in housing, than it is to have them be homeless," he says.

But getting housing isn't easy for those with limited means. And Hearne, like lots of people living in the streets, has a history marred with mistakes.

He was evicted from public housing years ago because he stabbed a neighbor in a fight. But he says he's already served his sentence � a three-year probation � and shouldn't be condemned to life, and maybe death, on the street.

Hearne and his wife have slept outside for much of the past four years, mostly under a highway across from the Health Care for the Homeless clinic. There are blankets, bags and mattresses stacked there, along a cement wall, and a few white buckets used as urinals. About two dozen people sleep there every night.

"I know it looks terrible, but this was our home," Hearne says. "We shouldn't have to live like this."

With that, he leans over to pick something up off the ground. It's a penny.

"A penny a day keeps the doctor away, right?" he asks. "That's what they say."

What they really say is that it's good luck. And maybe it worked. Health Care for the Homeless later found Hearne and his wife a new place to live.

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Tuesday, March 12, 2013

Affordable Care Act is Working to Bring Down Health Care Costs

Before the Affordable Care Act passed, the dramatic rise in health care costs put access to health care coverage out of reach for many Americans. With many people no longer able to afford coverage, the cost of uncompensated care in hospitals rose and those costs were passed along to people that could afford coverage. And, at the same time, health care�s share of the nation�s economy was growing rapidly.�

Three years later, the Affordable Care Act is working to bring down health care costs.

The law includes innovative tools to drive down health care costs.� It incentivizes efficient care, supports a robust health information technology infrastructure, and fights fraud and waste. ��After decades of growing faster than the economy, last year, Medicare costs grew by only four-tenths of a percent per person, continuing the trend of historically low Medicare growth seen in 2011 and 2010.

Major progress in Medicare is sparking smarter care in the private market, and it�s working to bring down costs in the private market. Overall health-care costs grew more slowly than the rest of the economy in 2011 for the first time in more than a decade. And just last week, USA Today reported health care providers and analysts found that �cost-saving measures under the health care law appear to be keeping medical prices flat.�

Even though the health care law is working to bring down costs, critics continue to claim the law is too expensive.� In reality, the law is fully paid for, and according to the independent Congressional Budget Office, the law reduces the deficit over the long term.� The facts show that employers, patients and our federal budget can�t afford to roll back the law now:

Fully repealing the Affordable Care Act would increase the deficit by $100 billion over ten years and more than a trillion dollars in the next decade.� It would also shorten the life of the Medicare Trust Fund by eight years.Health care spending grew by 3.9 percent in 2011, continuing for the third consecutive year the slowest growth rate in fifty years.Health-care costs grew slower than the rest of the economy in 2011 for the first time in more than a decade.The proportion of requests for double-digit premium increases plummeted from 75 percent in 2010 to 14 percent so far in 2013.Medicaid spending per beneficiary decreased by 1.9 percent from 2011 to 2012.Medicare spending per beneficiary grew by only 0.4 in fiscal year 2012.Slower growth is projected to reduce Medicare and Medicaid expenditures by 15 percent or $200 billion by 2020 compared to what those programs would have spent without this slowdown, according to CBO.

At the same time the law is driving down cost growth, the Affordable Care Act is strengthening coverage and expanding coverage.� Thanks to the law, more than 34 million people with Medicare received a no-cost preventive service.� And, over six million Medicare beneficiaries received $5.7 billion in prescription drug discounts.�

Some have proposed turning Medicare into a voucher program--undercutting the guaranteed benefits that seniors have earned and forcing them to pay thousands more out of their own pockets.� If we turn Medicare into a voucher program, our system doesn�t have any incentives to be more efficient and lower costs.� Instead, as costs rise, vouchers will leave seniors to pay more and more out of their own pocket. �

The health care law is working to lower costs, increase efficiency, and deliver better patient outcomes � without cutting costs at seniors� expense.� In recent years, we have seen dramatic slowing of the growth of federal health care programs.� The best approach to reducing our deficit is to continue implementing common-sense reforms.� The health care law is putting us on the right path to make Medicare and Medicaid stronger, more efficient and less costly.�

Sick From Fracking? Doctors, Patients Seek Answers

May 15, 2012

Listen to the Story 7 min 48 sec Playlist Download Transcript   Hide caption Michelle Salvini (left) and Terri DiCarlo take a break from work outside the Cornerstone Care clinic in Burgettstown, Pa. Mysterious fumes have repeatedly sickened clinic staffers, forcing them to evacuate the building several times. Previous Next Maggie Starbard/NPR Hide caption Environmental health specialist Dr. Michael McCawley (center) and Cornerstone CEO Robert Mt.Joy meet to talk about what's happening at the clinic. Previous Next Maggie Starbard/NPR Hide caption Cornerstone nurse Kay Allen (center) talks with her co-workers. Some staffers stopped coming into the clinic because of the fumes. Previous Next Maggie Starbard/NPR Hide caption The mystery ailments have prompted the clinic to relocate to a new site 30 minutes away. Here, a staffer sorts through patient files that will need to be moved. Previous Next Maggie Starbard/NPR Hide caption Richard Rinehart, who runs the clinic, wonders whether the natural gas drilling in the area may have something to do with what's been happening. Previous Next Maggie Starbard/NPR Hide caption Dr. Michael McCawley tests soil samples outside the clinic for elevated levels of pollutants. Previous Next Maggie Starbard/NPR Hide caption Receptionists Daralyn Fuller (left) and Miranda Thompson examine soil samples gathered outside the clinic. Previous Next Maggie Starbard/NPR Hide caption In early May, Cornerstone closed down its offices in Burgettstown, Pa., after two employees were hospitalized. The clinic plans to reopen in McMurray, Pa Previous Next Maggie Starbard/NPR Hide caption Receptionist Thompson talks with a patient in the doorway of the closed clinic. Previous Next Maggie Starbard/NPR Hide caption Burgettstown is located in a rural corner of southwest Pennsylvania. In the distance, lights mark a new gas well that's being drilled near the Cornerstone clinic. Previous Next Maggie Starbard/NPR

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Kay Allen had just started work, and everything seemed quiet at the Cornerstone Care community health clinic in Burgettstown, Pa. But things didn't stay quiet for long.

"All the girls, they were yelling at me in the back, 'You gotta come out here quick. You gotta come out here quick,' " said Allen, 59, a nurse from Weirton, W.Va.

Allen rushed out front and knew right away what all the yelling was about. The whole place reeked � like someone had spilled a giant bottle of nail polish remover.

"I told everybody to get outside and get fresh air. So we went outside. And Aggie said, 'Kay, I'm going to be sick.' But before I get in, to get something for her to throw up in, she had to go over the railing," she said.

Nothing like this had ever happened in the 20 years that Allen has been at the clinic. After about 45 minutes, she thought the coast was clear and took everyone back inside.

"It was fine. But the next thing you know, they're calling me again. There was another gust. Well, the one girl, Miranda, she was sitting at the registration place, and you could tell she'd had too much of it. And Miranda got overcome by that and she passed out," she said.

'It's The Unknown I Think That's The Scariest Thing'

This sort of thing has been happening for weeks. Mysterious gusts of fumes keep wafting through the clinic.

Science And The Fracking Boom: Missing Answers

Explore key components of the natural gas production process � and the questions scientists are asking.

View Interactive NPR

In fact, just the day before being interviewed by NPR, Allen suddenly felt like she had been engulfed by one of these big invisible bubbles.

"And all of a sudden your tongue gets this metal taste on it. And it feels like it's enlarging, and it just feels like you're not getting enough air in, because your throat gets real 'burn-y.' And the next thing I know, I ... passed out," Allen said.

Half a dozen of Allen's co-workers stopped coming in. One old-timer quit. No one can figure out what's going on. For doctors and nurses used to taking care of sick people, it's unnerving to suddenly be the patients.

"It's the unknown I think that's the scariest thing," she said.

Richard Rinehart, who runs the rural clinic, can't help but wonder whether the natural gas drilling going on all around the area may have something to do with what's been happening.

"I lay in bed at night thinking all kinds of theories. Is something coming through the air from some process that they're using? I know they use a lot of chemicals and so forth. Certainly that could be a culprit. We're wondering, Is something coming through the ground?" Rinehart said, noting that he'd just noticed a new drill on a hill overlooking the back of the clinic.

Now, no one knows whether the gas drilling has anything to do with the problems at the clinic. It could easily turn out to be something completely unrelated. There's a smelting plant down the road and old coal mines everywhere.

"Anything could be possible, and we just are trying to get to the root of it," he said.

Mysterious Symptoms, Lots Of Questions

People living near gas well drilling around the country are reporting similar problems, plus headaches, rashes, wheezing, aches and pains and other symptoms.

StateImpact

Shale Play: Natural Gas Drilling in Pennsylvania

Doctors like Julie DeRosa, who works at Cornerstone, aren't sure how to help people with these mysterious symptoms.

"I don't want to ignore symptoms that may be clues to a serious condition. I also don't want to order a lot of unnecessary tests. I don't want to feed any kind of hysteria," DeRosa said.

To try to figure out what's going on, the clinic called the Pennsylvania Department of Environmental Protection, which is investigating. It also started testing the air for chemicals, monitoring wind direction around the clinic and keeping diaries of everyone's symptoms. In addition, the clinic contacted Raina Rippel, project director for the Southwest Pennsylvania Environmental Health Project.

The local nonprofit was set up recently to help people in this kind of situation. Her team tested tap water from inside a men's room and from a stream out back.

Rippel says she knows people in the area have a lot of questions: "Is my water fit to drink? Is the air fit to breathe? Am I going to suffer long-term health impacts from this?"

Connecting Experts In Search Of Answers

To try to answer these questions, her project is connecting doctors and patients with toxicologists, occupational health doctors, environmental scientists and other experts.

"People go from physician to physician, because 'nobody seemed to be able to treat this awful rash that I have,' or 'nobody seemed to be able to deal with my gastrointestinal pain that I have.' And so they go from place to place, trying to find someone who can do that," said David Brown, a toxicologist who helped set up the project.

The project is also starting to educate doctors about what kinds of tests they can try and what kinds of advice to give. In addition, a nurse practitioner visits and counsels people who are sick.

Dr. Sean Porbin, a private doctor who advises the project, gives the project's nurse practitioner advice when she needs it. But Porbin is skeptical that many people are getting sick from the drilling, which is commonly called "fracking." There are about 5,000 new wells in Pennsylvania.

"If it's true, you'd expect people dropping all over the place based on the amount of fracking that's going on here. You would look around and see people dropping like flies. It's not the case. I don't see anybody affected. And it's not for a lack of looking," he said.

Porbin, who like a lot of people in the area has leased some of his land for drilling, wants to make sure no one's missing more mundane explanations � like Lyme disease, sinus infections and migraines.

"We have an old saying in medicine: When you hear hoof beats, you don't think zebras � you think horses," he said.

Lots Of Anecdotes, Little Evidence

The natural gas industry says there's no evidence the drilling is causing health problems.

Public health experts say the only way anyone is going to really know whether the drilling is making people sick is to do some big studies.

"There's a lot of anecdotal evidence out there. And so a well-conducted study looking at a number of communities could help us better understand if there's an impact, what its magnitude [is], how we should avoid having that impact if there is one," said Christopher J. Portier, director of the National Center for Environmental Health and the Agency for Toxic Substances and Disease Registry.

Explore Shale: Go deep inside the natural gas drilling process � and how it's regulated � in this interactive from Penn State Public Broadcasting.

In the meantime, patients and doctors don't have a lot of options. In western Pennsylvania, a lot of them are referred to Charles Werntz at West Virginia University. Werntz, an occupational medicine specialist, is used to dealing with chemical exposures. Lately, he's seeing more people who live near the drilling.

But for now, he says he can't really do much more than offer basic advice: Drink bottled water, air out the house, leave your shoes outside. If it's still too bad, move � if possible.

"It is frustrating. As a physician, I like it when somebody can come to me with a problem and I can help them solve the problem. Whether it's through a specific treatment or, you know, whatever. And this is frustrating, because in this case, the treatment is to get away from the exposure. And that's hard to do," Werntz said.

Back at Cornerstone, Rinehart just wants to get back to taking care of patients.

"We are in the business of trying to improve and maintain the public's health here. And now we are in the throes of it. And we're trying not to point fingers," Rinehart said.

The next day, people got sick again, and the clinic had to be evacuated once more. So they've moved the clinic to temporary offices until someone figures out what's going on.

Wednesday on Morning Edition, NPR's Jon Hamilton will report on researchers who think they have a good shot at answering whether drilling is making people sick.

The audio version of this story was produced by Rebecca Davis.

Web Resources Explore Shale: Go deep inside the natural gas drilling process � and how it's regulated � in this interactive from Penn State Public Broadcasting. Explore Shale: Go deep inside the natural gas drilling process � and how it's regulated � in this interactive from Penn State Public Broadcasting. Share 0Facebook 51Twitter Email Comment More From The Fracking Boom: Missing Answers Medical TreatmentsPennsylvania Doctors Worry Over Fracking 'Gag Rule'ScienceFracking's Methane Trail: A Detective StoryEnvironmentTown's Effort To Link Fracking And Illness Falls ShortEnergyMedical Records Could Yield Answers On Fracking

More From The Fracking Boom: Missing Answers

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As Big Employers Pinch Pennies, Health Savings Accounts Take Off

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By Putting Patients First, Hospital Tries To Make Care More Personal

More From Shots - Health News HealthRyan Budget Proposal Echoes Obamacare While Rejecting ItHealthCan Kidney Transplants Ease Strain On Gaza's Health System?HealthWhen It Comes To Health Care, Patients Don't Want To Weigh CostsHealthRoller Derby Players Swap Bacteria (And Shoves) On The Track

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Woman Charged In Death Of Fetus Is Out Of Jail

More From Shots - Health News HealthRyan Budget Proposal Echoes Obamacare While Rejecting ItHealthCan Kidney Transplants Ease Strain On Gaza's Health System?HealthWhen It Comes To Health Care, Patients Don't Want To Weigh CostsHealthRoller Derby Players Swap Bacteria (And Shoves) On The Track

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Monday, March 11, 2013

Treating Everybody With HIV Is The Goal, But Who Will Pay?

More From Shots - Health News HealthHardening Of Human Arteries Turns Out To Be A Very Old StoryHealthNew Voices For The Voiceless: Synthetic Speech Gets An UpgradeHealthDepression And Anxiety Could Be Fukushima's Lasting LegacyHealthAspirin Vs. Melanoma: Study Suggests Headache Pill Prevents Deadly Skin Cancer

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Ashley-Care: Gaining Peace of Mind by Getting Coverage Through a Parent’s Health Plan

Ashley Matthews, recent graduate of the University of Miami School of Law, considers herself very aware of what is going on the world. But she admits, �Because I am so young, health care never entered my universe.� That is, until she got into a car accident one evening. That�s when she realized she didn�t have health insurance.

As she recalls: �I�m laying on the hospital bed � my shoes were knocked off my feet, my tooth is chipped and my knee is bleeding and I thought about the fact that I had just graduated from undergrad [and] I had no health care insurance because I wasn�t on my parents� plan and this is right before the Affordable Care Act.� Although the doctor wanted her to stay in the hospital for treatment, Ashley and her friends quickly left because she would not be able to afford the care without health insurance. �The threat of the bills was enough to send me running from the hospital,� she says.

Because of the Affordable Care Act, Ashley was later able to be added to her parents� insurance. More than 3 million young adults have been able to gain health insurance through their parents� health plans until they turn age 26 as a result of the new health care law. �When I found out that I could stay on my parents� insurance, it was like a blessing,� she says.

Ashley, who now has a job and health insurance through her employer, says she wants other young adults to find out about the protections afforded by the health care law because �you never know what�s going to happen in life. � You never know when that one accident will change your life � You�re one diagnosis away from being destitute.�

��The Affordable Care Act has meant stability to me and it�s meant peace of mind� Ashley says. �I would want everyone to please just take advantage of the opportunities that have been created by the Affordable Care Act.�

To learn more about young adult coverage and other benefits of the health care law, visit here.

Sunday, March 10, 2013

5 Ways to Become an Informed Medicare Consumer

Each day, you make decisions about your finances, health, privacy, and more. It�s important to protect yourself and make the best choices for you, especially when it comes to your Medicare.

During National Consumer Protection Week (NCPW), non-profit organizations and government agencies give people like you information on how to take advantage of your rights and make better-informed choices. At Medicare, we�re here to help you become an informed Medicare consumer. Here are 5 things you can do:

Know your rights. As a person with Medicare, you have certain rights and protections (PDF- 780 KB) designed to help protect you and make sure you get the health care services the law says you can get.Protect your identity. Identity theft happens when someone uses your personal information without your consent to commit fraud or other crimes. Keep the following personal information safe: Your nameYour Social Security numberYour Medicare number (or your membership card if you�re in a Medicare Advantage or other Medicare health plan)Your credit card and bank account numbersGet more information on how to protect yourself from identity theft.Help fight Medicare fraud. Medicare fraud diverts money from the Medicare program each year, which means higher health care costs for you. Learn how to spot and report fraud.Get involved with other seniors with the Senior Medicare Patrol (SMP). The SMP educates and empowers people with Medicare to take an active role in detecting and preventing health care fraud and abuse.Make informed Medicare choices. Each year during the fall Open Enrollment Period (October 15-December 7), review your plan to make sure it�s going to meet your needs for the following year. If you�re not satisfied with your current plan, you can switch during the Open Enrollment Period.

Visit NCPW to learn more about the campaign, see which agencies and organizations are able to help you, and to find out if there are any NCPW activities happening in your area.

Ed Note: This blog originally appeared on Medicare.gov.

Saturday, March 9, 2013

Louisa-Care: Making Health Insurance More Affordable for Small Businesses

Louisa McQueeney is general manager and chief financial officer of Palm Beach Groves, a small, family-owned Florida gift and food shipping company. She believes it�s important for a small business to provide health insurance for its employees: �It creates a long-term relationship with your employees,� she says.

The health care law, Louisa says, is helping Palm Beach Groves continue to provide health coverage its employees by funding a health care tax credit for targeted small businesses. For Palm Beach Groves, that tax credit amounted to a $7,400 savings that could be used to offset health insurance costs. �

�It�s the first time in 12 years that I�ve actually seen a reduction in [health coverage] cost for the business,� Louisa says. �The decrease in our cost is directly tied to the tax credit. If it wasn�t for the Affordable Care Act, we would not be talking about a tax credit.�

Why Some Hospices Turn Away Patients Without Caregivers At Home

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Friday, March 8, 2013

For Midwife, 71, Delivering Babies Never Gets Old

March 6, 2013

Listen to the Story 7 min 31 sec Playlist Download Transcript  

Editor's Note: This video contains a scene of childbirth that includes graphic imagery and explicit language.

Credit: John W. Poole/NPR

Increasingly, people are continuing to work past 65. Almost a third of Americans between the ages of 65 and 70 are working, and among those older than 75, about 7 percent are still on the job. In Working Late, a series for Morning Edition, NPR profiles older adults who are still in the workforce.

Sometimes you can't retire even if you want to. For Dian Sparling, a certified nurse midwife in Fort Collins, Colo., there's no one to take over her practice. But at 71, she's finding that staying up all night delivering babies is harder than it used to be.

Sparling founded an obstetrics and gynecology practice called Womancare 31 years ago. During her career, she has delivered around 2,000 babies. Last year, she decided she'd retire from that part of her job, though she continued to see patients in the office. She didn't miss being on call � the person who's awakened in the middle of the night when a patient goes into labor.

"When you're on call, you just can't really plan for anything. You just need to be available, both physically and your heart and soul available, to do midwifery work. And when it's an unknown, I think it's a little bit more draining," Sparling says.

A few months ago, one of the other midwives in her practice had to take an extended medical leave. So Sparling had to go back to being on call.

Enlarge image i

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

Dian Sparling, a certified nurse midwife in Fort Collins, Colo., recently went back to being on call.

John W. Poole/NPR

"It would be horrible if I had to do this and stay up all night and didn't love what I do," she says.

'A Wonder To Behold'

It's just past daybreak at the hospital's birth center, and Sparling has been here since 4 a.m. with patient Amanda Trujillo, who is about to deliver her third baby. It's her second with Sparling as her midwife. The two are comfortable with each other. The atmosphere is relaxed. Sparling tells Trujillo to just be patient a little while longer.

When Sparling leaves Amanda and goes out to the nurses' station in the birth center, her spiky white hair sets her apart from her younger colleagues. Nurse Kathy Clarkson makes a point of telling her she was missed during her brief semi-retirement.

"We're glad that you're back working again, Dian," Clarkson says. "When you retired, we were all crying."

Nurse Julie Christin says that as a midwife, Sparling works more closely with women in labor than do most MDs.

"Physicians rely on us to do a lot of the labor support," Christin says. "But Dian spends a lot of time with her patients when they're in labor. I like that, because then she's involved and can make decisions quicker, and does what the patient wants to do, which is good."

Sparling is "in tune with them emotionally as well as physically," Clarkson says.

And then it's time for Sparling to get back in tune with Trujillo, who's ready to start pushing. Her husband, Isaiah, supports one leg, and delivery nurse Keri Ferguson supports the other.

“ It would be horrible if I had to do this and stay up all night and didn't love what I do.- Certified Nurse Midwife Dian Sparling As Amanda Trujillo works, her husband, Sparling and Ferguson cheer her on and report on the baby's progress. First his head emerges. Then his shoulders. And finally, there is a new little person named Samuel in the world, though at nearly 9 pounds, maybe not so little. "There he is, Amanda," Sparling says. "Reach down here and grab your baby." Samuel is born just before 10 a.m. Sparling has been at the hospital for six hours. And she's jazzed. "People have asked me, 'Does this feeling after a delivery ever get old?' Absolutely not," she says. "It's a wonder to behold, and my adrenaline stops pumping about two hours after a delivery. And then I can go to sleep." But it takes her twice as long to recover from an all-nighter as it used to. Her closest friends worry about her. Sparling is long divorced. Her two sons live back East, so this group of friends are the ones she refers to as her "support people." "We think she should be retired, but she doesn't think she can," says Sparling's friend, Wayne Peak. "She's our age and we're retired and we like to travel and relax a whole bunch, and she's on call and has to stay up in the middle of the night and deliver babies. That's not good." More In This Series Working Late: Older Americans On The Job When A Bad Economy Means Working 'Forever' Working Late: Older Americans On The Job For One Senior, Working Past Retirement Age Is A Workout Working Late: Older Americans On The Job At 85, 'Old-School' Politician Shows No Signs Of Quitting

Another friend, Nancy Grove, says she was not happy when Sparling first told her she was going back to being on call.

"Once I stopped thinking about myself and started thinking a little more about Dian, I really wanted to support her in what she wants to do, needs to do, because she's a very valuable asset in our community," Grove says.

A Line In The Sand

Sparling has reassured her friends that she will not keep delivering babies forever. In a way, she longs for retirement � from deliveries, from the office, from work. But that would mean finding someone to take over her practice and run it the way she believes it should be run. For instance, no patient is turned away because of lack of insurance or inability to pay.

"The truth of the matter is this is not a money-making business," Sparling says. "It makes our salaries. It makes our health care insurance payments for ourselves, it pays for our malpractice insurance, which is required by the state and also by our hospital. We can exist and pay for ourselves, but it doesn't make money."

Sparling says that at 71, she realizes time is not on her side. As much as she loves her work, she wants to pursue the other pleasures of life.

"One of which is travel. There are so many places in the United States and the world that I would love to go," Sparling says. "And one is taking piano lessons. I was given a piano at age 7 by my grandmother, and really never made proper use of it and practice. And you need time to do that."

Sparling has given herself deadlines for retiring before. None have stuck. But she's still trying.

"And now I guess I can draw a line in the sand and say it's going to be [at] 75, I will no longer be seeing patients in the office," she says.

But she acknowledges that maybe a line in the sand isn't the best metaphor. She says, "you know how sand flows."

Share Facebook Twitter Email Comment More From Working Late: Older Americans On The Job Around the NationFor Midwife, 71, Delivering Babies Never Gets OldAround the NationAt 85, 'Old-School' Politician Shows No Signs Of QuittingAround the NationWhen A Bad Economy Means Working 'Forever'EconomyWorking Late: In Tough Economy, Retirement Gets Pushed Back

More From Working Late: Older Americans On The Job

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Wednesday, March 6, 2013

Infections With 'Nightmare Bacteria' Are On The Rise In U.S. Hospitals

More From Shots - Health News HealthInfections With 'Nightmare Bacteria' Are On The Rise In U.S. HospitalsHealthA Costly Catch-22 In States Forgoing Medicaid ExpansionHealthOften A Health Care Laggard, U.S. Shines In Cancer TreatmentHealthGot A Health Care Puzzle? There Should Be An App!

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Tuesday, March 5, 2013

Medicaid and the Affordable Care Act

The Affordable Care Act ensures that all Americans have access to quality, affordable health care.� It works with States to establish State-based Health Insurance Exchanges so that consumers have the ability to shop for coverage in a competitive marketplace and insurers are made to compete on the basis of cost and quality. And it takes important steps to make coverage more affordable for millions of people, families, and small businesses. To achieve this, the health law provides:

Tax credits for individuals and families purchasing coverage in the Exchanges with income from 133 to 400 percent of the Federal poverty level, as well as those ineligible for Medicaid with income between 100 and 133 percent of poverty.

Medicaid for most Americans with income below 133 percent of the federal poverty level (about $15,000 for an individual, $20,300 for a couple).�

In carrying out the law, we need to make sure Americans can easily understand their coverage options and their eligibility for premium tax credits based on their income. �Many people and families receive income from a variety of sources. For example, some people receive Social Security benefits in addition to income they may earn at their job.� Long-standing tax law excludes a portion of Social Security benefits from income to reduce seniors� tax bill.� The income definition used in the health care law for tax credits and Medicaid also uses this exclusion, creating something known as your �modified adjustment gross income.��

Medicaid is a vital program, providing health benefits to nearly 50 million Americans, most of them with very low incomes including women and their children, people with disabilities, and many seniors who are living in nursing homes. That�s why we have worked with States to keep costs down and sustain coverage in the program as the economy is recovering.� And that�s why we are fighting efforts in Congress to end Medicaid as we know it and replace it with a block grant.

However, we are concerned that, as a matter of law, some middle-income Americans may be receiving coverage through Medicaid, which is meant to serve only the neediest Americans.� We are exploring options to address this issue, so that we can use taxpayer dollars responsibly while ensuring that all Americans have access to affordable, high quality health insurance coverage.

Note: this blog was updated on June 22.

Monday, March 4, 2013

If Health Law Falls, Coverage For Young Adults Gets Tricky

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Sunday, March 3, 2013

HealthMap Vaccine Finder: Helping Adults Find the Vaccines They Need

When we talk about vaccines, most people think of �flu� or �childhood immunizations.� But there are actually a number of vaccines available to protect adults from serious infectious diseases and their long-term consequences. Adult vaccines can prevent diseases such as shingles, pneumonia and whooping cough. The HPV vaccine can prevent cervical cancer. And the hepatitis B vaccine also prevents the liver cancer that can develop as a result of chronic hepatitis B infection.

In the past many Americans faced financial barriers to immunization, but thanks to the Affordable Care Act, millions of Americans now have free access to the vaccines recommended by the Advisory Committee on Immunization Practices without co-payments or other cost-sharing requirements when those services are delivered by an in-network provider.

Despite the numerous benefits of vaccination, too many adults are not getting the protection that they need.� So, starting this month, it will be even easier for adults to find where to get vaccinated. Now, you can just go online and enter an address or zip code and HealthMap Vaccine Finder will locate nearby immunization providers (including health clinics and pharmacies) that offer the vaccinations routinely recommended for adults. In addition to telling people where to get the flu vaccine, the HealthMap Vaccine Finder will now tell consumers where to find providers of 10 other vaccines, including:

Hepatitis AHepatitis BHerpes Zoster (Shingles)HPV (Human Papillomavirus)MMR (Measles, Mumps, Rubella)Varicella (Chickenpox)Td (Tetanus and Diphtheria)Tdap (Tetanus, Diphtheria, and Pertusis)MeningococcalPneumococcalhttp://wcdapps.hhs.gov/Badges/Handlers/Badge.ashx?js=0&widgetname=vaccinefinderw199

The new HealthMap Vaccine Finder is an expansion of the Flu Vaccine Finder, and lists more than 50,000 providers across the country that offer flu vaccinations, searchable by vaccine delivery type (nasal spray, shot, etc.) and location. To find out where to get vaccinated in your area, go to vaccines.gov!

What Obama’s Next Steps Should Be on Health Care

The following article is from AlterNet. AlterNet asked dozens of writers, experts and activists on key issues to write about where the country needs to go, and the priorities for Barack Obama’s early days in office.

By Sara Robinson, fellow, Campaign for America’s Future

The most important thing for incoming Obama policy makers to remember right now is that, while Obamacare is a fine step in the right direction, they shouldn’t be shy about using the words “single payer.” (Or, put it another way: Medicare for all.) The K Street lobbyists for the insurance and pharmaceutical companies may scream bloody murder whenever the idea is floated, but the polls over the past several years have shown irrefutably that the American public — including a majority of Republicans — is behind this idea at least 2 to 1. That’s a lot of political cover, and they should take full advantage of it to do the right thing.

It’s also an absolutely necessary thing. American workers are competing with European and Canadian workers who have the choice to go back to school, start a small business, take time off and travel, stay home with their kids for a few years, fully recuperate from a disabling condition, or tell their boss where they can stick it without the threat of losing their insurance. Having guaranteed health care not only makes these workers physically healthier and extends their productive years; it also increases these countries’ social and economic capital by enabling them to become better skilled, better traveled, more entrepreneurial and more personally fulfilled. American workers simply can’t compete on an equal footing in a tight global labor market until they have equal access to care.

It’s also the right thing to do economically. A new Harvard Law School study found that more than half of the mortgage defaults underlying the subprime meltdown were triggered by overwhelming medical bills or job loss due to disability. It’s probably not an overstatement to say that much of America’s current financial distress is the direct product of our health care crisis. (It’s ironic that the same financial wizards who so boldly proclaimed that we were all on our own — or should be — are now losing everything because they simply didn’t notice how interconnected these issues are. If they’d shared just enough of their loot to ensure that Americans had decent health care, they’d still be Masters of the Universe. They didn’t. So we don’t. So they aren’t. Who says there’s no such thing as karma?)

Most importantly: It’s the best thing an incoming Obama administration can do to usher in a new and enduring progressive era. Giving every American access to health care will do more to undercut the entire conservative worldview and replace it with a new progressive political philosophy than anything else you can name. Once people realize that government can do this much good for this many people, it will restore our faith in the power of democracy — and when that happens, all manner of now-impossible things will suddenly become possible.

Friday, March 1, 2013

New Report Shows Slower Medicaid Spending Growth

The 2012 Medicaid Actuarial Report released today contains good news. �It shows that estimated Medicaid benefits spending will decrease by 1.9% per beneficiary from 2011 to 2012. �This decline in per beneficiary spending is virtually unprecedented. �Except in 2005-2006, when the cost of prescription drugs for Medicaid-Medicare dual beneficiaries shifted to Medicare Part D, Medicaid spending per beneficiary has never declined from one year to the next in the 47-year history of the program.� Health care spending growth has generally been slow over the past few years, but Medicaid spending growth in 2012 is well below spending growth in the rest of the health care economy.

These results can be interpreted to suggest that Medicaid programs managed spending growth more effectively than did other payers in 2012. �And that states have substantial flexibility to manage Medicaid spending growth.

Projected spending growth per beneficiary over the next decade is only 3.2% per year, less than the rate of growth of the per capita Gross Domestic Product, and lower than projected growth in overall per person health spending. �As a result of Medicaid expansion in 2014, a larger proportion of Medicaid beneficiaries will be relatively low cost healthy adults, and a smaller proportion will be relatively high cost disabled and aged beneficiaries, and the changing mix of Medicaid beneficiaries accounts for part of the reason that projected Medicaid spending growth is so slow.� But even focusing separately on projected rates of growth for children, adults, disabled and aged beneficiaries, the projections show a program with modest expenditure growth per person.

Furthermore, largely because of the decrease in Medicaid spending and a slower growth rate than was assumed last year, in this year�s report projected spending in 2020 is fully 14% lower than the projection made in last year�s report.�

There are very strong financial and economic arguments in favor of states expanding Medicaid eligibility to 133% of the federal poverty level. �From 2014 through 2016, 100% of the costs of covering newly eligible people will be paid by the Federal government, with that percentage gradually decreasing to 90% by 2020.� That means that over the next decade more than 90% of the total costs for newly eligible people will be paid for by the Federal government, representing substantial new flow of Federal funds to hospitals and other health care providers in states that choose to expand.� This will undoubtedly lead to more jobs and tax revenue, as well as improved health and financial security for millions of newly insured low-income workers.�

While the baseline assumption in today�s report is that, in 2015, 65% of newly eligible Medicaid beneficiaries will live in states that have chosen to expand Medicaid, today�s report underscores substantial uncertainty about state decisions. We remain optimistic that, over time, all states will recognize the health, financial, and economic benefits of extending Medicaid.� These new data suggest just how effectively the Medicaid program manages spending growth, and is well positioned to accommodate future beneficiaries.

To read today�s report on the financial outlook for Medicaid, visit: http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Financing-and-Reimbursement/Actuarial-Report-on-Financial-Outlook-for-Medicaid.html

And for a letter from Secretary Sebelius to governors detailing more information on the flexibility states have in designing their Medicaid programs, see:� http://medicaid.gov/State-Resource-Center/Events-and-Announcements/Downloads/Markell-and-Fallin-Letter.pdf (PDF - 223 KB)

States Taking the Lead in Strengthening Consumer Protections

Recently, five more States strengthened their laws protecting consumers in disputes with their health insurance plans. The District of Columbia, Massachusetts, New Hampshire, Ohio and Wisconsin have bolstered their laws surrounding the part of the appeals process known as �external review.� �These five States join 33 others that provide these State-based external review protections that ensure consumers have a voice. The remaining States� consumers are protected by a Federal process.

The strengthened appeals rights are one of several common-sense consumer protections and insurance market reforms established by the Affordable Care Act. Having a meaningful appeals process ensures that you actually receive the benefits that your insurer has promised.

So, what exactly is an external review?�

It means having an independent third party review your insurer�s decision, no matter where you live, thanks to the Affordable Care Act.

Often, you can resolve disputes with your health plan by asking your insurer to reconsider its decision, in a process known as an �internal appeal.� But if, for example, your insurer still denies payment after the internal appeals process, you now can ask for an external review by an independent review organization to decide the matter.� Insurance companies must accept the outcome of this external review.� This means that your insurance company no longer gets the final say, and that patients and doctors get a greater measure of control over health care decisions.

These protections are important because when an insurer refuses to pay for a covered health care service, consumers could be faced with a large unplanned bill, and may not be able to afford the care their doctors say they need.

The Affordable Care Act sets these new important appeals standards for consumer protections and encourages States to take the lead in ensuring their own residents benefit from them.� Where States have not yet passed laws implementing these consumer protections, HHS has set up a process to ensure that consumers in these States also benefit from the same protections and standards.� If a State changes its external review process in the future, the State may request a new determination at any time.�

Having DC, Massachusetts, New Hampshire, Ohio and Wisconsin step up to the plate to ensure consumers� external review rights is a perfect example of how the Affordable Care Act empowers States to protect consumers.