Health and Medical News and Resources

General interest items edited by Janice Flahiff

Two postings about proposed state Medicaid expansion (The Health Care Blog)

 

Yes, this is a controversial topic, but thought I’d include these items, the comments for both blogs are interesting.
My thoughts? Health insurance coverage does need revising..because caring for our nation’s health is a shared responsibility…

Why Should You Care Whether or Not Your State Decides to Expand Medicaid Coverage?

By expanding Medicaid, the state-federal partnership that offers health insurance to low-income Americans, the Affordable Care Act set out to cover some 17 million uninsured – or roughly half of the 34 million who are expected to gain coverage under reform. But when the Supreme Court ruled on the Affordable Care Act in June, it struck down a key provision which threatened that if a state refused to co-operate in extending Medicaid to more of its citizens, it could lose the federal funding it now receives for its current Medicaid enrollees…

..

Health care costs, premiums would rise

What these governors ignore is the impact that the loss of those Medicaid dollars will have on insurance rates in their states, says Joe Paduda, editor of Managed Care Matters. Hospitals have been counting on the influx of new Medicaid dollars to reduce the cost of uncompensated care. Today, hospitals spend billions delivering care to patients who are both uninsured and very poor. If more patients have Medicaid, the pile of unpaid bills will shrink.

Assuming that Medicaid will expand, the Affordable Care Act has already trimmed subsidies to hospitals that care for a disproportionate share of impoverished patients. But now, if states turn down the Medicaid funding, the hospitals in these states “are going to have to make up the revenue loss from somewhere,” says Paduda, “and that ‘somewhere’ is going to be from privately-insured patients. That will lead to health insurance costs increasing much faster in ‘non-expansion’ states than in the rest of the country.”

We have been told that in some red states conservatives “hate poor people.” But my guess is that they’ll hate higher premiums more. If premiums go up, governors who turned down federal Medicaid dollars will have to answer to voters…

Now that some states are balking, the Congressional Budget Office estimates that 6 million of the 17 million who were supposed to be covered by the Medicare expansion will be left out of the program. Fortunately, 3 million of those 6 million will be eligible for sliding-scale subsidies that the ACA provides to help low-income and middle-income Americans purchase private insurance – if they earn between 100 percent and 400 percent of the federal poverty level. ($11,170 to $43,320 for an individual).

What is less fortunate is that the CBO estimates that those subsidies will cost Washington $3,000 more per person than if the same people were covered by Medicaid: private health insurance plans have higher administrative costs than Medicaid and also tend to pay providers more.

3 million left out in the cold

The other 3 million will be left out in the cold. The subsidies, which come in the form of tax credits, are earmarked for those who earn between 100 percent and 400 percent of the federal poverty line. Ironically, if a person earns “too little” (less than 100 percent of the FPL), they are not eligible for the subsidy. (The ACA assumed that they would be covered by the new Medicaid.)

At the same time, if they earn “too much” to qualify for Medicaid in a state that limits eligibility to 50 percent of the FPL, they will be shut out of that program as well – leaving them in a no-man’s land where they have no sure access to medical care.

In those cases where they do receive the care they need, the rest of us will wind up covering their unpaid bills as we watch our insurance premiums climb.

The Supreme Court May Have Saved Lives … by Keeping People Off Medicaid

magine that you are the head of a family of three, struggling to get by on an income, say, of $25,000 a year. You’ve signed up for your employer’s health plan because you want your family to get good health care when they need it. But that takes a big bite out of your paycheck — $250 a month.

When you first heard about the president’s health plan, you heard him say that if you like the plan you’re in you can keep it. That was good news. You also believed the whole point of the reform was to help families like yours get health insurance if for some reason you had to seek insurance on your own.

 

Now get ready for some surprises. The first will be an announcement that in another year or so your employer’s health plan will no longer be available to you. The reason: plain economics. People at your income level will qualify for as good or better health insurance in a new health insurance exchange. And almost all the premium will be paid for by the federal government. Most people like you would rather have higher wages than a health plan that duplicates what you can get almost for free, your employer will reason. So in order to compete for labor, your company will have to give prospective employees the compensation package they most want. And your employer will be right.

Then there will be a second surprise. Under the new rules, if you are eligible for Medicaid, you can’t get private insurance in the exchange. Further the health reform law is designed to force the states to raise the income level for Medicaid. If your state complies, someone with your income will be eligible for Medicaid and you won’t be allowed in the exchange!

Now if you were a resident alien, the rules are different. Since they don’t generally qualify for Medicaid, immigrant families at your income level can get subsidized private insurance in the exchange. But alas, you’re a citizen. So this option isn’t open to you.

Now let’s say you are under the impression that Medicaid is second rate insurance and you remember that your employer promised to pay more in wages once your health benefit is gone. What about using the higher wages from your employer to buy private insurance outside the exchange?

Now get ready for the third surprise. There isn’t going to be any market for private insurance outside the exchange — at least not for you. The insurance companies are going away. The brokers are going away. The market is going away.

Now for the final surprise. The only option open to you under the Affordable Care Act is Medicaid! Why should you care? Because your initial impression is correct. Medicaid is second rate insurance.

In most places Medicaid patients have a terrible time finding doctors who will see them and facilities that will admit them. That’s why so many of them turn to community health centers and the emergency rooms of safety net hospitals for basic medical care. Medicaid enrollees turn to emergency rooms for their care twice as often as the privately insured and even the uninsured. In fact, if you’re trying to get a primary care appointment, it appears your chances are better if you say you are uninsured…

..

Here is where is gets little bit tricky, owing to the bizarre structure of ObamaCare. The new health law is trying to get the states to expand Medicaid eligibility to 138% of the federal poverty level ($15,415 for an individual or $26,344 for a family of three). But let’s suppose that, thanks to the Supreme Court, a state doesn’t do anything. It turns out that only people who are between 100% and 138% of poverty can then go into the exchange and get private insurance.

So if your employer does raise your pay and pushes you over that threshold, you qualify. However, while your salary is still only $25,000 you may not be eligible for Medicaid. Here’s the double whammy:  You will not be allowed into the exchange either. You will be in a sort of “no-man’s-land” donut hole. And the only way out will be for you to somehow earn more income. Or, lie about it. This may be one of the very few instances where people will find it their self-interest to tell the IRS their income is higher than it really is!

According to the CBO about two-thirds of the states will not expand eligibility above 100% of the federal poverty level. That’s why 3 million citizens will be liberated and will get private insurance instead. Moreover, the subsidies in the exchange are incredibly generous. The most the family has to pay is 2% of their income.

Further, the private plans in the exchange will pay providers about 50% higher fees that the rock bottom payments they would have gotten from Medicaid. This will be a huge relief for safety net facilities that are scraping by on inadequate resources as it is. And it’s a reason why the CBO may have underestimated how many states will find this option very attractive.

ObamaCare is still a Rube Goldberg contraption that desperately needs repealing and replacing. But in the interim, the Supreme Court has done a lot of families a big favor.

 

August 8, 2012 Posted by | Uncategorized | , , , | Leave a comment

Getting Physical With Unruly Kids

 

From the 7 August 2012 article at Medical News Today

Parents get physical with their misbehaving children in public much more than they show in laboratory experiments and acknowledge in surveys, according to one of the first real-world studies of caregiver discipline.

The study, led by Michigan State University’s Kathy Stansbury, found that 23 percent of youngsters received some type of “negative touch” when they failed to comply with a parental request in public places such as restaurants and parks. Negative touch included arm pulling, pinching, slapping and spanking…

..Stansbury said another surprising finding was that male caregivers touched the children more during discipline settings than female caregivers – and the majority of the time it was in a positive manner. Positive touch included hugging, tickling and patting.

She said this positive approach contradicts the age-old stereotype of the father as the parent who lays down the law.

“When we think of Dad, we think of him being the disciplinarian, and Mom as nurturer, but that’s just not what we saw,” Stansbury said. “I do think that we are shifting as a society and fathers are becoming more involved in the daily mechanics of raising kids, and that’s a good thing for the kids and also a good thing for the dads.”

Ultimately, positive touch caused the children to comply more often, more quickly and with less fussing than negative touch, or physical punishment, Stansbury said. When negative touch was used, even when children complied, they often pouted or sulked afterward, she said.

“If your child is upset and not minding you and you want to discipline them, I would use a positive, gentle touch,” Stansbury said. “Our data found that negative touch didn’t work.”

 

August 8, 2012 Posted by | Psychology | , | Leave a comment

Off-Label Drug Use Common, but Patients May Not Know They’re Taking Them

 

From the 6 August 2012 article at Science News Daily

Many people have probably heard of off-label drug use, but they may not know when that applies to prescriptions they are taking, a Mayo Clinic analysis found. Off-label drug use occurs when a physician prescribes medication to treat a condition before that use has been approved by the Food and Drug Administration.

In a newly published article in Mayo Clinic Proceedings, researchers pose and answer 10 questions about off-label drug use.

“Since the Food and Drug Administration does not regulate the practice of medicine, off-label drug use has become very common,” says lead author Christopher Wittich, M.D., internal medicine physician at Mayo Clinic. “Health care providers and patients should educate themselves about off-label drugs to weigh the risks and benefits before a physician prescribes one or a patient takes one.”

Some highlights from the article:

* Off-label drug use is common. Within a group of commonly used medications, roughly 1 in 5 prescriptions were for an off-label use, a 2006 report found. Another study found that about 79 percent of children discharged from pediatric hospitals were taking at least one off-label medication.

* Patients may not know when drugs they have been prescribed are being used off-label. No court decision has required that physicians must disclose, through informed consent, the off-label use of a drug, the authors say. The FDA makes clear that it doesn’t regulate the practice of medicine and that the federal Food, Drug, and Cosmetic Act of 1938 doesn’t make physicians liable for off-label drug use, they note.

* Off-label drug use can become the predominant treatment for a condition. For example, some antidepressants are not approved by the FDA as a treatment for neuropathic pain, yet some drugs in this class are considered a first-line treatment option.

* Examples of widely practiced off-label drug use include morphine, used extensively to treat pain in hospitalized pediatric patients. Many inhaled bronchodilators, antimicrobials, anticonvulsants, and proton pump inhibitors also are used in children without formal FDA approval.

* Obtaining new FDA approval for a medication can be costly and time-consuming. To add additional indications for an already approved medication requires a supplemental drug application; if eventually approved, revenue from it may not offset the expense and effort for obtaining approval.

* Generic medications may not have the requisite funding resources needed to pursue FDA-approval studies. For these financial reasons, drug proprietors may never seek FDA approval for a new drug indication.

* Pharmaceutical manufacturers are not allowed to promote off-label uses of medications. However, they can respond to unsolicited questions from health care providers and distribute peer-reviewed publications about off-label use. Just this year, GlaxoSmithKline agreed to pay a record $3 billion to settle a Justice Department case involving alleged off-label drug use marketing, and Merck Sharp & Dohme was fined $322 million over its alleged promotion of the painkiller Vioxx for an off-label use.

 

 

August 8, 2012 Posted by | health care | , , | Leave a comment

Health Insurance: Those Who Are Covered, Recover

 

From the 7 August 2012 article at Science News Daily

Underinsured CVD patients die sooner than patients with private insurance, irrespective of race…

Insurance status is a better predictor of survival after a serious cardiac event than race, and may help explain racial disparities in health outcomes for cardiovascular disease. A new study by Derek Ng, from the Johns Hopkins Bloomberg School of Public Health in the US, and his team shows that race is not linked to an increased risk of death but being underinsured is a strong predictor of death among those admitted into hospital with a serious cardiac event. Their work appears online in the Journal of General Internal Medicine, published by Springer…

g and colleagues looked at whether the risk of early death was associated with insurance status or race. They took into account the potential effects of neighborhood socioeconomic status and disease severity. They analyzed data from a sample of patients admitted to one of three Maryland hospitals for three specific cardiovascular events: 4,908 with acute myocardial infarction (or heart attack); 6,758 with coronary atherosclerosis (or furring up of the arteries); and 1,293 with stroke.

They found that underinsured patients died sooner than patients with private insurance, whereas the survival rates were comparable between whites and blacks. More specifically, underinsured patients had a 31 percent higher risk of early death after a heart attack and a 50 percent higher risk after atherosclerosis. This survival effect was independent of race, neighborhood socioeconomic status and disease severity.

The authors conclude: “Among those admitted to the hospital with an acute cardiovascular event, there was an increased risk of mortality among subjects who were underinsured compared to those who had private insurance. Given the recent changes in health insurance and healthcare reform, these results underscore the need to closely investigate the factors relating to health insurance that may explain these disparities. Indeed, targeting these factors may relieve the burden of mortality disproportionally affecting those who are underinsured.”

 

August 8, 2012 Posted by | health care | , , , , | Leave a comment

Breast cancer screening ad campaign criticized

 

English: SAN DIEGO (Sept. 22, 2008) Lead Mammo...

English: SAN DIEGO (Sept. 22, 2008) Lead Mammography Technologist Carmen Waters, Naval Medical Center San Diego (NMCSD) Breast Health Center, assists a patient preparing for a mammography. In conjunction with NMCSDs pharmacy, the Breast Health Center has started a new program called “Mammograms While You Wait” which allows patients to take the exam while their prescriptions are being filled. (U.S. Navy photo by Mass Communication Specialist 2nd Class Joseph Moon/Released) (Photo credit: Wikipedia)

 


 

 

Komen adThe Komen Foundation’s ad campaign for breast cancer screening was criticized in a BMJ article by Dartmouth’s Steve Woloshin and Lisa Schwartz, who wrote: “Unfortunately, there is a big mismatch between the strength of evidence in support of screening and the strength of Komen’s advocacy for it.”

Take your pick of places to read more about it:

  • Susan Perry of MinnPost.com wrote: “The commentary is part of BMJ’s “Not So” series, which the editors call an “occasional series highlighting the exaggerations, distortions, and selective reporting that make some news stories, advertising, and medical journal articles ‘not so.'” I wish I could send MinnPost readers to the BMJ website to read it, but for reasons that are inexplicable to me, the journal has decided to keep this paper behind a paywall.

 

 

August 8, 2012 Posted by | health care | , , , | Leave a comment

Scientific Results of Yoga for Health and Well-Being

 

Helen yoga

Helen yoga (Photo credit: Wikipedia)

 

From the Web page at the US National Center for Complementary and Alternative Medicine

 

This video features the current scientific evidence for yoga as a complementary health practice, particularly for symptoms like chronic low-back pain. Viewers will also learn about research that explores the safety of yoga and how certain yoga poses can specifically affect a person’s body. The video also provides valuable “dos and don’ts” for consumers who are thinking about practicing yoga. This is the second installment in NCCAM’s The Science of Mind and Body Therapies video series.

Yoga is a mind and body practice with historical origins in ancient Indian philosophy. Like other meditative movement practices used for health purposes, various styles of yoga typically combine physical postures, breathing techniques, and meditation or relaxation.

 

 

On a related note…

 

Twitter Chat: Yoga

 

The experts for this month’s chat will be Dr. Karen Sherman, senior scientific investigator at Group Health Research Institute, and NCCAM staff member and certified yoga teacher Yasmine Kloth. The chat will take place on August 21, 2012 at 1:00 p.m. ET. Join at #nccamchat.
https://nccam.nih.gov/news/events/twitterchat?nav=upd

 

 

 

August 8, 2012 Posted by | Health Education (General Public) | , , | Leave a comment

US federally funded health centers finding aid (they only charge what you can afford)

From a recent use.gov email

National Health Center Week (August 5-11) serves as a reminder that you can get medical treatment even if you don’t have health insurance.Federally funded health centers provide:

  • Checkups
  • Treatment for illnesses
  • Care during pregnancy
  • Immunizations and checkups for children
  • Dental care and prescription drugs
  • Mental health and substance abuse care

August 8, 2012 Posted by | health care | | Leave a comment

Hospital delirium: not as negligible as previously thought

 

University of NE Medical Center in midtown Omaha

University of NE Medical Center in midtown Omaha (Photo credit: Wikipedia)

 

My sister, a nurse practitioner, posted this on Facebook. Something to keep in mind if you have a loved one in ICU..

 

From the 6 August article at Nebraska Live Well

 

Medical professionals once thought patient delirium was a benign byproduct of landing in an intensive care unit.

Now they know otherwise.

Delirium caused by medications, illness and other sources can lead to permanent confusion and death, say experts in ICU delirium.

The Nebraska Medical Center has tested a new set of strategies to combat and diminish hospital delirium. Although the results haven’t been compiled yet, scientists and medical practitioners hope the protocol will make a difference in patients’ conditions in the hospital and after release.

We used to think it just goes away,” Michele Balas, a faculty member at the University of Nebraska Medical Center, said of delirium. Balas, whose doctorate is in nursing, has overseen the research.

Delirium can affect people for the rest of their lives, she said, and may cause depression, memory loss and post-traumatic stress disorder, and affect the cognitive functions required for such simple tasks as balancing a checkbook or following a recipe.

Sedation, sometimes used when patients are on ventilators or are delirious, makes it impossible for them to regain alertness and get up, Balas said. Prolonged bed rest can cause pneumonia and blood clots,

The strategy, called ABCDE, involves getting patients off sedation as soon as possible (Awakening); removing them from ventilators for at least a while so they breathe on their own (Breathing); communication and coordination (C) among doctors, nurses and others; delirium monitoring by staffers (D); and early mobility (E), or getting them up and moving as soon as possible, even patients on ventilators

 

 

 

 

August 8, 2012 Posted by | health care | , , | Leave a comment

   

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