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A Few Ways the Government Shutdown Could Harm Your Health (And the World’s) by Maryn Mckeena

There’s going to be a lot — a lot — of coverage today on the federal shutdown, what it means and how long it might go on. I thought it might be worth quickly highlighting how it affects the parts of the government that readers here care most about: public health, global health, food safety and the spread of scary diseases.

Most of those government functions are contained within the Cabinet-level Department of Health and Human Services, where 52 percent of the employees have been sent home. So the news is not good.

The US Centers for Disease Control and Prevention furloughed 68 percent of its people — not just here in Atlanta, but globally. Yesterday I asked a longtime acquaintance there what was likely to happen and she said:

I know that we will not be conducting multi-state outbreak investigations. States may continue to find outbreaks, but we won’t be doing the cross-state consultation and laboratory work to link outbreaks that might cross state borders, such as a recent Hep A outbreak. We will not be doing rapid response for vaccine preventable disease cases or outbreaks, such as measles. We won’t be monitoring seasonal influenza activity in the U.S. as flu season begins.

Surveillance for other emerging infectious disease outbreaks, such as H7N9 and MERS, will be weakened. We won’t be doing routine inspections of BSL3 and BSL 4 labs as part of the select agent program. Our work to prevent HIV/STDs and TB in the states using molecular epidemiology will be discontinued.

Let’s unpack that a little bit. In the US, the flu season is beginning. This year’s flu vaccine has been manufactured, and is either already in the hands of state and local health departments, or with doctors or on its way to them via the commercial middlemen who handle distribution for the manufacturers. (On Twitter today, Jim Garrow of the Philadelphia Department of Public Health confirmed that they already have an inventory of flu vaccine.)

So flu prevention won’t necessarily be harmed — except for those people who don’t get a flu shot unless the CDC’s public health campaigns remind them, because there won’t be any such campaigns. But flu surveillance, which the CDC conducts and also assembles out of data sent to it by health departments and by networks of physicians, is on the shelf. Here’s what the CDC’s flu-surveillance homepage looks like right now:

original page here.

And here is what that means: We are now at the start of flu season. If this season becomes a bad one — a rogue virus, an uneven epidemic, a concentration of cases in the elderly or the very young or in a particular city or state — we’ll have no way of knowing. And, for what it’s worth, no way of directing additional public-health or research help, because they’ve all been sent home. In tracking flu, one of the most unpredictable and mutable human-disease viruses around, we have been blinded. And if the shutdown continues more than a few weeks, then that blindness will also blanket development of next year’s flu vaccine — because within a few weeks, CDC researchers would start analyzing this year’s northern and southern hemisphere viruses to determine what ought to be included in next year’s vaccine mix.

That blindness also is not limited to the US. The CDC loans scientists and sends money to the World Health Organization and to dozens of countries in the industrialized and developing worlds. One of its specialties is helping to track the emergence of new flu viruses that have pandemic potential. That global spyglass has just been shuttered. And: we are less than two weeks from the official beginning of the hajj, the worldwide pilgrimage of observant Muslims to the holy sites of Saudi Arabia — where, if you’ve been following along, MERS has been slowly growing for more than a year. Health planners have been quietly fretting for months that the hajj might allow the spread of MERS outside of the Middle East — a reasonable fear, as that has happened in past hajj seasons with other diseases. But with the shutdown, we lose some of the most accurate tools for finding that out.

And this enforced ignorance of disease spread isn’t hypothetical. Just this morning, the WHO tweeted that there is a three-country outbreak of more than 200 cases of polio in the Horn of Africa. The top polio-hunters in the worldwide eradication effort, the ones who developed the “molecular clock” that allows the eradication campaign to trace new cases back to their source, work at… yup, the CDC.

The shutdown’s risks to health aren’t limited to what the CDC does. The Food and Drug Administration has sent home 45 percent of its staff. The ones who remain can do so because they work in programs that receive user fees, such as reviews of proposed new pharmaceuticals; those can continue provided the application for review was already submitted. (New reviews, according to the FDA’s statement today, are out of luck.) But food safety — always an under-funded mandate — is in real danger. HHS’s memo on shutdown staffing acknowledged this:

FDA will be unable to support the majority of its food safety, nutrition, and cosmetics activities. FDA will also have to cease safety activities such as routine establishment inspections, some compliance and enforcement activities, monitoring of imports, notification programs (e.g., food contact substances, infant formula), and the majority of the laboratory research necessary to inform public health decision-making.

Translated, that means: No foodborne outbreak tracking; no inspection of food imports; no lab research; no publishing of guidance documents. (Food Safety News and Regulatory Focus have more.)

At the US Department of Agriculture — which attends to about 15 percent of the US food supply, including meat, compared to the FDA’s 85 percent — things are a bit better. Eighty-seven percent of its staff have been retained, including most of the Food Safety and Inspection Service. In its shutdown memo, the USDA says the FSIS falls under an Office of Management and Budget shutdown category described as “necessary to perform activities necessarily implied by law” (for wonks, that’s No. 3 of the five categories). Thus, they can continue to conduct meat, poultry and egg inspections on-site, that is, at plants and packing houses. However, the agency loses personnel as follows:

The following headquarters staffs performing the central program guidance, coordination, direction and planning functions described will be furloughed except as minimally required in direct support of Agency field operations:
•Inspection Operations (Office of Field Operations): Responsible for planning, coordinating and directing the Meat, Poultry, and Egg Products Inspection programs. Due to the large numbers of in plant inspection personnel who support excepted activities, most individuals in this area would be excepted and on duty.
•Public Health Science (Office of Public Health Science): The Public Health Science Program is responsible for planning, coordinating and directing all scientific guidance and support in chemistry, epidemiology, pathology, toxicology, nutrition, and parasitological. The Public Health Science Program also performs Agency risk assessments, directs the residue testing program, and also performs activities that address zoonotic diseases. With the exception of the laboratory function within Public Health Science, designations for these functions would be non-excepted, with limited individuals being identified as excepted and on duty. The majority of all Laboratory functions will be excepted.
•International Programs (Office of Field Operations, Office of Policy and Program Development, and Office of Investigation, Enforcement and Audit): The International Programs are responsible for ensuring that meat, poultry, and egg products from foreign countries are safe and wholesome. Program personnel also confer with foreign governments on issues involving imports and exports of meat, poultry and egg products and international food safety standards. A substantial number of these programs other than inspection of imports and certifying products for export would not be excepted.

I know other Wired colleagues are going to tackle the shutdown’s effect on the rest of the government science apparatus. There is no question, though, that public and global health and food safety are experiencing great impact. Better hope there are no major outbreaks brewing, and that no food producer or manufacturer — or food importer in a country with lower standards — decides that now is the time to try to slip something by government-funded detection and response. As of this morning, the protections we rely on are no longer there.

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U.S. healthcare stat by David Heitz

Bloomberg news’s recent Best (and Worst) Lists include a run-down of U.S. healthcare information that may not be common knowledge for American workers and patients.

The Good

1. The U.S. ranks a respectable seventh among the best countries for workers. Countries in which workers did not have to spend a lot of money on healthcare ranked higher on the list.

The list included the 34 countries with membership in the Organization for Economic Cooperation and Development (OECD). Ireland, France, and Iceland led the list. The Czech Republic, Hungary, and Mexico rounded it out.

2. Two industries related to healthcare are among the most likely to hire new employees, including biotechnology and pharmaceuticals (No. 7) and healthcare facilities and services (No. 9).

“Over the past 20 years, most of the wage increases that might have gone to average workers have not because they have been absorbed by additional healthcare costs,” said Dr. Mark Smith, president and CEO of California HeathCare Foundation. “But some of that additional health care cost goes into more and more jobs.”

Hardware technology, technology services, and software led the list.

3. Healthcare companies dominate the list of the 25 most innovative U.S. companies. Cyberonics, Inc., a medical technology company specializing in neuromodulation, led the list. Other companies included Allergan, Celgene, Roper Industries, Medidata, Thoratec, Danaher, and Covidien.

Bloomberg used several data to score companies, including the amount they spend on research and development.

Tom Hubbard, vice president for policy research at the New England Healthcare Institute, said much of the innovation goes into developing drugs. “There have been drugs for every sort of category, but where there has been intense innovation and a lot of the cost is on drugs for very serious illness,” he said.

11 Ways to Save Money on Healthcare

The Bad

4. Among U.S. companies with the highest profits, two pharmaceutical giants make the list: Pfizer (No. 11) and Johnson & Johnson (No. 15). Tobacco giant Philip Morris is No. 20.
5. Three heathcare related companies make the list for the biggest increase in spending on lobbying in the past year, including Merck, Johnson & Johnson, and Proctor & Gamble.

To add a twist, the No. 2 big spender is Phillip Morris. The cigarette manufacturer spent $9.8 million on lobbying efforts in 2012, about half the expenditure of the list leader, Google.

This comes as no surprise given the intense national conversation about health, Smith said.

Healthcare: Where Does All the Money Go?

The Ugly

6. The U.S. ranks 46th out of 48 countries for health care efficiency, behind Libya, Malaysia, Cuba, Saudi Arabia, Greece, Romania, and Iran. Hong Kong topped the list.

Bloomberg ranked the countries based on life expectancy and the per capita cost of healthcare.

But Smith says Bloomberg’s methodology is flawed. “Life expectancy is a really important number, but if you’re trying to judge efficiency of a healthcare system and you’re rating life expectancy, that’s where I get off the bus,” he told Healthline.

He said cultural factors, such as diet and smoking prevalence, are also important. “I don’t think you’d want to be in the clutches of the Romanian healthcare system,” Smith added.
7. The U.S. ranks last in the world for paid time off. In this country, there is no guarantee of any paid time off whatsoever. Austria and Portugal led the list, with 35 paid days off per year for each worker.
8. The United States is (almost) the fattest country in the world. Bloomberg has the U.S. topping their list, but more recent data show Mexico now holds the title.

“I think it is clear that it’s hard to run an ‘efficient’ healthcare system and contain costs given the prevalence of obesity,” said Randy Seeley, Ph.D., director of the Cincinnati Diabetes and Obesity Center. “Even worse, the onset of obesity is getting younger, and the percentage of individuals at the heaviest BMIs [body mass indexes]—and therefore the most severe and expensive complications—is growing the fastest.”

Smith said the Bloomberg lists point to an essential conflict in American policy. “There is a story to be had in the struggle and tension between our national priority on reducing healthcare costs and the fact that healthcare has been one of the few sectors that is growing,” he said.

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American medical tourists visit other countries to save

Joy Guion of Hickory, N.C., recently took her first trip on a plane – a flight to the sun-soaked Central American tourism hot spot, Costa Rica, to stay at a four-star hotel with a local driver and personal concierge – but a full-fledged vacation this is not. Because of a family history of diabetes and heart decease, Guion, 39, went to Costa Rica for weight loss surgery.

Joining her on the trip was Gary Harwell, 65, a retired manager at the same plant where Guion works, who was getting knee replacement surgery.

Their company is paying the entire bill. It gave them a choice: Choose a traditional insurance plan or outsource their care in a foreign country for certain surgeries.

Americans have long gone abroad for medical care, but now more and more U.S. companies are footing the bill.

HSM, the furniture manufacturer in western North Carolina where they both work, said that offering its workers “medical tourism” has saved it nearly $10 million in health care costs over the past five years. Close to 250 employees have traveled abroad so far, and more are scheduled to go, the company says.

In the U.S., Harwell’s knee replacement would have cost more than $50,000; in Costa Rica, it’s half that, $23,531. Back home, Guion’s gastric sleeve surgery goes for about $30,000; in Costa Rica it’s less than $18,000.

In the U.S., each of them would have had to pay $3,000 out of pocket, but in Costa Rica, they will not only get all their trip expenses paid, they’ll both also get bonus checks for at least $2,500 from their company, a percentage of the corporate savings in insurance costs.
After surgery in a state of the art facility, it’s off to a private room with an extra pullout bed for a friend or relative, all surprisingly as pristine as any you’d find in the U.S.

But medical experts do caution there are potential problems with having medical procedures done overseas.

“There have been reported documented cases of fatalities involving people going to various centers,” said Glenn Cohen, a medical ethicist at Harvard University. “There have been reported cases of people bringing back multi-drug-resistant organisms for example from India to Sweden. There are real problems if you have to sue for medical malpractice because the tort occurred abroad. And there could be real difficulties in translation or the quality of the documents you can bring back, which may make it more difficult to get good follow-up care back in the U.S.”

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Competition in Health Exchanges is for the greater good

Government officials have said that the exchanges will keep insurers’ prices down by making them compete with each other. Prices on the exchanges have been lower than government forecasts, partially a sign of “healthy competition,” Cohen says, and are generally lower in more competitive markets. So far, though, the marketplaces seem to be having another effect on major insurance companies, too: Scaring them away.

Large insurers like Cigna and UnitedHealth have abstained from many states’ exchanges this year; Aetna has backed out of seven exchanges it originally applied to, instead “focusing on the markets where we can be most competitive and deliver the greatest value to our customers,” a spokesperson says. In Mississippi, 36 counties would not have had any plan options if Humana had not joined at the 11th hour, Melville says. “There were concerns there would be coverage deserts, there would be places that you wouldn’t be able to get a policy.” This hasn’t happened, but some states have so few carriers offering plans in the marketplaces that the lack of competition has kept rates high.

West Virginia and New Hampshire, for example, currently have only one carrier for their entire states, respectively. Wyoming only has two, after most of the state’s insurers skipped the exchange, and has the highest rates in the country. Analysts, however, say that there is likely to be more competition in future years: Insurers will wait and see how 2014 plays out and re-evaluate their strategies. Aetna, for one, says it is “taking a measured, multiyear approach to exchanges.”

Insure your retirement income for life with Indexed Annuities

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With Indexed Annuities, you get the potential of an inflation-beating return and have 100% safety against market risk of not only your principal, but also of all your previous years of gains?

In 2008, the owners of Indexed Annuities did not lose a penny.

Some indexed annuities pay a deposit bonus.

So, if you are a retiree who has money in any tax-deferred plan and you like the prospect of growing your retirement account with zero market risk, Indexed Annuities is your answer.

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OBAMACARE Q&A (answers to your questions) by Tara Siegel Bernard

Given all of the rhetoric about the Obama administration’s health care law, it’s not surprising that many consumers are confused about how the new insurance exchanges will actually work. Some states that oppose the law have gone as far as intentionally limiting the information that trickles out to its residents.

Robert Neubecker

What questions do you have about how the Affordable Care Act affects you? Leave them in the comments below, and Tara Siegel-Bernard will answer a selection in the coming week.

  • But after much anticipation, the curtain will finally rise on the exchanges next week, providing millions of consumers with an online marketplace to compare health insurance plans and then buy the coverage on the spot.

The exchanges are likely to be most attractive to people who qualify for subsidized coverage. Individuals with low and moderate incomes may be eligible for a tax credit, which can be used right away, like a gift card, to reduce their monthly premiums. People with pre-existing conditions will no longer be denied coverage or charged more (this applies to most plans outside the exchanges, too). And all of the plans on the exchanges will be required to cover a list of essential services, from maternity care to mental health care.

“In today’s individual market, it’s like Swiss cheese coverage,” said Sarah Dash, a research fellow at the Health Policy Institute at Georgetown University. “Consumers should have an easier time figuring out what they are getting for their money.”

But it’s still going to take some time to analyze the plans and their costs, which are expected to vary widely across the states. And the coverage may still pinch many families’ budgets. Fortunately, there’s a six-month window, from now to March 31, for people to figure it all out.

Here’s some information to get you started:

Q. Where can I apply or get more information on the exchanges?

A. To avoid fraud artists, enter through the front door: Healthcare.gov. From there, you can find links to the exchange offered in your state. There may be technical glitches as the program gets started, so alternatively, you can call 1-800-318-2596.

Q. When does coverage go into effect?

A. You can apply as early as Oct. 1, but coverage won’t begin until Jan. 1. The enrollment period for coverage in 2014 closes on March 31, 2014. After that, you can enroll only if you have a major life event like a job loss, birth, marriage or divorce.

Q. What sort of coverage will be offered?

A. All plans will have to provide the same set of essential benefits, including prescriptions, preventive care, doctor visits, emergency services and hospitalization (this also applies to most individual and small-employer group plans sold outside of the exchanges). But plans can offer additional benefits, or different numbers of services like physical therapy, so you’ll need to do a side-by-side comparison to see what fits your needs — or at least the needs you can anticipate.

Q. Are the plans sold on the exchange more comprehensive than plans outside?

A. There are four plan levels, each named for a precious metal. They all generally offer the same essential benefits, but their cost structures vary. The lower the premium, the higher the out-of-pocket costs.

The bronze level plan, for instance, has the lowest premiums, but will require consumers to shoulder more costs out of pocket. They generally cover 60 percent of a typical population’s out-of-pocket costs, and include deductibles, co-payments and coinsurance. The silver plans cover 70 percent; gold, 80 percent; while platinum covers 90 percent (and therefore carries the highest premiums).

If you buy a plan on an exchange, your annual out-of-pocket costs cannot exceed $6,350 for individuals and $12,700 for a family of two or more in 2014. Catastrophic plans are also available to people under age 30 or those suffering a financial hardship. These carry high deductibles (equivalent to the out-of-pocket maximum, or $6,350 for a single person, in 2014). You cannot apply tax credits to these plans, either.

Premiums will vary across the states because of a variety of factors, like market competition, the underlying cost of care and the negotiating power of the exchanges, according to Kaiser research.

Q. If the costs with plan levels are similar, how will plans differ within the metal levels?

A. Networks of doctors and hospitals will differ, and cost-sharing structures may also vary. One plan might have lower deductibles and higher co-pays, whereas another plan might have a separate deductible for prescriptions. Various medications may also be covered differently. “If you are someone who is taking medicines, make sure you know what your drugs will cost in the various plans being offered,” said Cheryl Fish-Parcham, deputy director of health policy at Families USA, a Washington consumer advocacy group.

Q. Will I be eligible for a premium tax credit (subsidized coverage)?

A. People with income between 100 percent of the poverty line (or about $23,550 for a family of four) and 400 percent of poverty ($94,200 for a family of four) are eligible for a tax credit to defray premium costs. (All income eligibility is based on your modified adjusted gross income; the online version of this column links to a guide explaining how that is calculated).

The tax credits are set up so that consumers will not have to pay more than a certain percentage of their income, ranging from 2 percent for those with incomes of up to 133 percent of the poverty level ($15,282 for a single and $31,322 for a family of four) to 9.5 percent for those with income of 300 to 400 percent of the poverty level, according to the Center on Budget and Policy Priorities. The dollar amounts of the credits are calculated based on the costs of the second-to-lowest-cost silver plan available to you.

Kaiser has a calculator that can give you an idea of your eligibility.

Q. Can I get help with my out-of-pocket expenses, like deductibles?

A. People with incomes between 100 percent of the federal poverty line ($23,550 for a family of four) and 250 percent ($58,875 for a family of four) are also eligible for cost-sharing reductions, which means you’ll pay less for items including deductibles and co-payments, and you’ll have lower out-of-pocket maximums.

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Plan for financial retirement should start when we are 25yrs of age

About 90% of Americans engage in some sort of personal financial planning, but few have a clear, well-rounded approach to reaching their goals. This month, the Certified Financial Planner Board of Standards and the Consumer Federation of America released the 2013 Household Financial Planning Survey and Index, which detailed the four categories of planners among American consumers.

The study followed the 2012 Household Financial Planning Survey, released by the same organizations, which tied the time and effort put into planning to better financial outcomes. The 2013 survey was conducted April 12 to 24 by Princeton Data Source and has a margin of error of plus or minus 3.5 percentage points. The index awarded consumers points for specific financial behaviors that fell into three categories: comprehensive financial planning, basic financial planning and credit card debt management.

Based on scores from those criteria, Americans fell into one of four groups. In the report, they are called the comprehensive planners, basic planners, limited planners and non-planners. Here’s who they are:

The Perfectionists — (Comprehensive Planners) 19% of Americans

These consumers know the exact route to their financial goals, whether they drew the map themselves or sought professional planning guidance. Not only do they have a household budget, which includes retirement savings and insurance, but they work toward specific savings goals.

  • Two-thirds use a Certified Financial Planner or registered investment adviser for planning assistance.
  • 88% have a specific plan for retirement.
  • 80% have a plan for emergency savings.
  • More than half have a household income greater than $100,000.

The Dreamers — (Basic Planners) 38% of Americans

Most consumers fall in this category. They have some goals worked out and have an idea of what they’d like to achieve — they just haven’t yet worked out all the details. For instance, Dreamers may have savings plans for retirement or education, but they haven’t pulled everything together to form an overarching plan.

  • Two-thirds have a household budget.
  • Less than half of them write down their budget or store it electronically.
  • 35% have a comprehensive plan.
  • 31% are likely to make that plan within the next year.

4 Money Mindsets: Which is Yours?

The Procrastinators — (Limited Planners) 33% of Americans

These consumers put forth the bare minimum and might get to the rest of planning later. Most in this group have a budget or plan to address savings goals, but not both. Their comprehensive financial planning behaviors don’t differ much from non-planners — they’re nearly nonexistent in both groups — but some Procrastinators keep a written budget, and they tend to avoid racking up credit card debt.

  • 31% plan for retirement, but only 7% save for emergencies, and only 7% save for anything else.
  • 11% are likely to make a comprehensive plan within the next year.
  • 44% have a household budget (only 15% write it down).

The Wanderers — (Non-Planners) 10% of Americans

In this group, consumers just kind of float from bill to bill without any strategic approach to money management. They exhibit nearly no comprehensive financial planning behaviors, with less than 1% likely to create a comprehensive plan in the next 12 months. Wanderers are about as likely as Perfectionists to take on $5,000 or more in credit card debt, while 45% of them have a household income of less than $25,000.

  • 90% have no plan in place for specific savings goals.
  • 40% have significant credit card debt.
  • Half of them have no plan to pay down that debt.

In general, planners exhibited more confidence in financial decision-making and saved more money. For comparison: 53% of Perfectionists feel very confident in their financial decisions, while only 26% of Wanderers felt that way. On the flip side, 41% of Wanderers said they had little or no confidence, and only 6% of Perfectionists expressed that sentiment.

Such confidence comes from understanding one’s financial situation. With the wealth of planning tools available online, from budgeting to student loan management, anyone can set financial goals. A great way to take stock of your financial picture is to check your credit health using a free tool like Credit.com’s free Credit Report Card. It allows consumers to check their credit score and identify areas that need work on a monthly basis. Free tools like that help make financial planning accessible for consumers of any money mindset.

The bottom line? Yes, planners tend to make more money, but good decision-making doesn’t come with cash. Regardless of income level, planners achieved better financial outcomes than non-planners.

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Start saving at 25yrs old or prepare for new careers when you are older

  • A 25-year-old just starting to save would only need put away about $160 each month to generate $1,000 in monthly retirement income.
  • Start saving at age 35 and you’ll need to contribute almost $270 a month to generate the same income.
  • For every $1,000 in monthly income, a 45-year-old just beginning to save for retirement would have to put away nearly $500 every month.
  • A 55-year-old just starting to build a nest egg would have to make monthly contributions of $1,154 for every $1,000 in monthly retirement income—that’s double the amount of a 45-year-old and more than seven times the sum that a 25-year-old would need to stash away.

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My state of Kentucky needs Obamacare Health Care now by Steve Beshear

RANKFORT, Ky. — SUNDAY morning news programs identify Kentucky as the red state with two high-profile Republican senators who claim their rhetoric represents an electorate that gave President Obama only about a third of its presidential vote in 2012.

So why then is Kentucky — more quickly than almost any other state — moving to implement the Affordable Care Act?

Because there’s a huge disconnect between the rank partisanship of national politics and the outlook of governors whose job it is to help beleaguered families, strengthen work forces, attract companies and create a balanced budget.

It’s no coincidence that numerous governors — not just Democrats like me but also Republicans like Jan Brewer of Arizona, John Kasich of Ohio and Rick Snyder of Michigan — see the Affordable Care Act not as a referendum on President Obama but as a tool for historic change.

That is especially true in Kentucky, a state where residents’ collective health has long been horrendous. The state ranks among the worst, if not the worst, in almost every major health category, including smoking, cancer deaths, preventable hospitalizations, premature death, heart disease and diabetes.

We’re making progress, but incremental improvements are not enough. We need big solutions with the potential for transformational change.

The Affordable Care Act is one of those solutions.

For the first time, we will make affordable health insurance available to every single citizen in the state. Right now, 640,000 people in Kentucky are uninsured. That’s almost one in six Kentuckians.

Lack of health coverage puts their health and financial security at risk.

They roll the dice and pray they don’t get sick. They choose between food and medicine. They ignore checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a condition turns out to be nothing. And they live knowing that bankruptcy is just one bad diagnosis away.

Furthermore, their children go long periods without checkups that focus on immunizations, preventive care and vision and hearing tests. If they have diabetes, asthma or infected gums, their conditions remain untreated and unchecked.

For Kentucky as a whole, the negative impact is similar but larger — jacked-up costs, decreased worker productivity, lower quality of life, depressed school attendance and a poor image.

The Affordable Care Act will address these weaknesses.

Some 308,000 of Kentucky’s uninsured — mostly the working poor — will be covered when we increase Medicaid eligibility guidelines to 138 percent of the federal poverty level.

PricewaterhouseCoopers and the Urban Studies Institute at the University of Louisville concluded that expanding Medicaid would inject $15.6 billion into Kentucky’s economy over the next eight years, create almost 17,000 new jobs, have an $802.4 million positive budget impact (by transferring certain expenditures from the state to the federal government, among other things), protect hospitals from cuts in indigent care funding and shield businesses from up to $48 million in annual penalties.

In short, we couldn’t afford not to do it.

The other 332,000 uninsured Kentuckians will be able to access affordable coverage — most with a discount — through the Health Benefit Exchange, the online insurance marketplace we named Kynect: Kentucky’s Healthcare Connection.

Kentucky is the only Southern state both expanding Medicaid and operating a state-based exchange, and we remain on target to meet the Oct. 1 deadline to open Kynect with the support of a call center that is providing some 100 jobs. Having been the first state-based exchange to complete the readiness review with the United States Department of Health and Human Services, we hope to become the first one to be certified.

Frankly, we can’t implement the Affordable Care Act fast enough.

As for naysayers, I’m offended by their partisan gamesmanship, as they continue to pour time, money and energy into overturning or defunding the Affordable Care Act. It’s shameful that these critics haven’t invested that same level of energy into trying to improve the health of our citizens.

They insist that the Affordable Care Act will never work — when in fact a similar approach put into effect in Massachusetts by Mitt Romney, then the governor, is working.

So, to those more worried about political power than Kentucky’s families, I say, “Get over it.”

The Affordable Care Act was approved by Congress and sanctioned by the Supreme Court. It is the law of the land.

Get over it … and get out of the way so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life.

Steve Beshear, a Democrat, is the governor of Kentucky.

my wish for my man

my wish is for my man to weather the storms in his life with ease

to not gamble but to to take calculated risk
to embrace new emotions, to love with wild abandon
to be open to new opportunities
to not assume that others will be open to one’s own assumptions and needs
to ask for in the end, your request will be granted if it is a win win situation
parenting takes two, allow your partner to take half of the load
to rest when your body needs to
to venture to projects you love to do the most
to learn to dance and just do it
to let time be the judge to what the future holds
for life should be experienced fully with another
as two hearts are creating far more colorful life
for not acting is not making the future.

Understanding Health Exchanges or health insurance marketplaces, Obamacare

Understanding exchanges

A guide to help employers navigate the new health care market

The Affordable Care Act (ACA) includes provisions that extend health coverage to millions of Californians. Rules governing individual health insurance are changing to promote broader risk pooling and standardized age rating, prohibit discrimination because of health status and pre-existing conditions, and improve insurance market efficiency.

With the ACA, most Americans will be required to have health coverage after January 1, 2014. And they’ll have a new way to buy health policies through insurance exchanges set up in each state.1 Your employees will look to you for advice and assistance as they navigate the exchanges, so we’re providing you with information about their new options — as well as exploring the role brokers will play with the agency running California’s exchanges, Covered California.

What to expect and when

Beginning with plans effective as of January 1, 2014, purchasing health coverage may change for you and your employees under the ACA. Exchanges will provide individuals and small business owners with a place to find, compare, and purchase coverage, as well as get financial assistance to afford it.

Benefits of the exchanges

The exchanges will allow individuals and small business owners to compare health plans and purchase one that covers essential health benefits. While individuals and small business owners aren’t required to use exchanges, they may offer advantages for you and your employees.

Types of exchanges

Covered California offers two types of exchanges — an individual exchange and the Small Business Health Options Program (SHOP). For California, a small group is currently defined as having 50 or fewer eligible employees. In 2016, small groups will be defined as those with 100 or fewer eligible employees.

Help with Covered California

One of the greatest challenges for many individuals and small business owners will be navigating their new health coverage options — especially if they’ve never purchased coverage before. It’s expected that brokers will play a role in helping people learn about their health coverage options and providing enrollment support.

What you’ll get through the exchanges

  • Some small business owners will be able to reduce costs by taking advantage of available tax credits, which are available only by purchasing coverage through the SHOP.
  • Small business owners will be relieved of the administrative burden of choosing plans to meet all workforce needs.
  • Small business owners will be able to offer a defined contribution, simplified by receiving one bill and the ability to write one premium check for all employee-selected plans.
  • Your employees will get a broad choice of high-quality health plans.
  • Premium tax credits and cost-sharing reductions will only be available through the individual exchange.
  • A dedicated website and toll-free hotline will make it easier for individuals and families to compare plans by cost, quality, and coverage.

Covered California will provide information and decisions on employee eligibility for Medi-Cal. And by using Covered California’s online calculator, you’ll be able to determine the actual cost of your coverage.

Open enrollment

The SHOP

Although January 1, 2014, is the first effective date for plans, exchanges must be ready for business in time for the initial open enrollment period beginning October 1, 2013. The SHOP permits qualified employers to purchase coverage at any time during the year after October 1, 2013.

Individual Exchange

Unlike the SHOP, the individual exchange will permit individuals to enroll in coverage only during the initial enrollment period from October 1, 2013, to March 31, 2014 — and thereafter during an open enrollment period that will begin on October 15 and last through December 7 annually. There will be special open enrollment periods for triggering events such as marriage, the birth of a child, and loss of employer-based coverage.

Working with Covered California

Covered California will offer plans to both individuals and small groups. You can make plan choices through the appropriate Covered California option.

Get to know Covered California

Covered California’s stated mission* is to increase the number of insured Californians, improve health care quality, lower costs, and reduce health disparities through an innovative, competitive marketplace that empowers consumers to choose the health plan and providers that give them the best value.

Meeting the needs of individuals and families

Each insurer in Covered California will offer a range of plans to suit individuals and families with a variety of needs. And financial assistance will be available to eligible individuals who don’t have:

  • Medicare
  • Medi-Cal
  • affordable coverage
  • coverage meeting the minimum value requirement through an employer
  • incomes exceeding certain levels

Individual financial assistance is only available through the individual exchange, not through the SHOP.

Financial assistance and penalties for individuals

Many consumers may be eligible for premium tax credits to help with their health care premiums, including U.S. citizens or legal residents:

  • who have to pay more than 9.5% of their income for employer-sponsored health care coverage based on the cost of self-only coverage, or whose employer-sponsored coverage doesn’t meet the minimum value requirement and whose modified adjusted gross income falls between 133 and 400% of the federal poverty limit (FPL)
  • who aren’t eligible for Medi-Cal
  • who don’t have access to an employer-sponsored health care plan that meets minimum essential coverage requirements and whose modified adjusted gross income falls between 133 and 400% of the FPL†

Some individuals may also qualify for a cost-sharing reduction to help reduce out-of-pocket costs. To purchase coverage through the individual exchange, you must live in California and be a U.S. citizen or legal resident of the United States. Individuals who choose not to buy insurance may have to pay a tax penalty that will increase over a period of years. The penalty for not purchasing insurance is the greater of:

  • 2014 — $95 per uninsured person (up to a maximum of no more than 300% of the cost per person) or 1% of household income over the filing threshold
  • 2015 — $325 per uninsured person (up to a maximum of no more than 300% of the cost per person) or 2% of household income over the filing threshold
  • 2016 — $695 per uninsured person (up to a maximum of $2,085) or 2.5% of household income over the filing threshold
  • 2017 — $695 (increased by the cost-of-living adjustment) or 2.5% of household income over the filing threshold

Certain individuals are exempt from the penalty or aren’t required to purchase insurance, including individuals with religious objections, individuals who are certified as being unable to afford coverage, Native Americans, undocumented immigrants, and the incarcerated.

The SHOP

Small business owners can purchase coverage through Covered California’s SHOP. It gives smaller employer groups a broader choice of health plans and eliminates plan participation requirements. In 2014, small businesses with fewer than 25 full-time employees that pay an average annual wage of less than $50,000 and that contribute 50 percent or more toward their employees’ self-only premiums may be eligible to receive up to a 50 percent federal tax credit for coverage purchased through the SHOP. Tax-exempt small businesses may receive a credit of up to 25 percent for 2013. In 2014, this rate for tax-exempt small businesses increases to 35 percent. Although you can purchase coverage outside of the SHOP, you won’t receive the tax credit if you do so.

With the SHOP, you can choose the level of coverage, or “metal” tier, you want to offer and the contribution you want to make toward coverage. Small business owners can offer employees a choice of plans from several insurance companies, with the convenience of receiving a single bill and writing a single premium check.

How Covered California works

When Covered California opens in October 2013 for open enrollment, you and your employees will be able to either call or log on to its website to see what plans are available and whether you qualify for any financial assistance. By law, all exchanges — including Covered California — will certify which Qualified Health Plans will be offered.

Choosing health plans in the exchanges

Insurers that want plans included in Covered California’s exchanges must submit bids. To be selected as a Qualified Health Plan, plans must offer the essential health benefits package and meet all other ACA requirements.

Functions the exchange will perform in order to evaluate potential plans include:

  • ensuring that the plan’s bid includes one standard plan design for each metal tier
  • confirming the actuarial value for each plan submitted
  • confirming each plan’s geographic service area
  • encouraging plans to adopt delivery system reforms such as patient-centered medical homes, accountable care organizations, proven chronic disease management programs, and effective quality and patient safety initiatives

Qualified Health Plans — the metal tiers

The plans offered by Covered California will fall into four metal tiers — bronze, silver, gold, and platinum. Each metal tier corresponds to an actuarial value, which is a measure of how much of the cost for covered services would be paid by the plan. For example, a gold plan with an actuarial value of 80 percent would be expected to pay an average of 80 percent of a standard population’s expected medical expenses, with individuals covered by the plan expected to pay the remaining 20 percent through deductibles, copays, and other cost-sharing features. Health plans and insurers who participate in — and sell products outside of — the exchange must offer, market, and sell the same products they make available to individuals and small employers in the exchange as to those purchasing coverage outside the exchange.

The four metal tiers and their actuarial values are:

  • Platinum — 90% actuarial value
  • Gold — 80% actuarial value
  • Silver  — 70% actuarial value
  • Bronze — 60% actuarial value

There will be a catastrophic plan designed for people under 30 and those who can’t afford other coverage. For those eligible to purchase this coverage, the catastrophic plan will also fulfill the individual mandate to enroll in minimum essential coverage. This plan provides for essential health benefits, but no benefits other than three primary care visits are covered until the individual meets the annual deductible, which is similar to that of a high-deductible health plan. Premium tax credits aren’t available for catastrophic plans.

For more information

Visit these resources for more information on exchanges in general and specific information about Covered California.

1 The U.S. Department of Health and Human Services recently began referring to exchanges as health insurance marketplaces. Throughout this document, we refer to the more widely known term of exchange.

† Eligibility for financial assistance varies by state.

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The age you retire

The age you collect Social Security

While you can start Social Security payments as early as age 62, you won’t get the full amount you have earned until your full retirement age. The full retirement age is 66 for most baby boomers and 67 for everyone born in 1960 or later. A worker born in 1965 who signs up for Social Security at age 62 will get monthly payments that are 30% smaller than if he or she waits until age 67 to begin collecting payments.

“If you sign up before age 66 or your full retirement age, it is discounted, and you are basically shortchanging yourself of getting the full benefit that you earned. That discount carries through your entire life until you die,” says Brent Neiser, a certified financial planner and a senior director at the National Endowment for Financial Education in Denver. Checks further increase by 8% for each year you delay claiming up until age 70. “Try to make your Social Security payment as large as possible when you claim it because you are going to have this lasting payment over time,” Neiser says. After age 70, there is no additional benefit for waiting to claim Social Security.

Meeting Medicare’s deadlines

The standard Medicare Part B premium is $104.90 per month in 2013 for all retirees who earn less than $85,000 ($170,000 for couples). To pay this premium, you need to sign up for Medicare during the seven-month initial enrollment period that begins three months before you turn 65 and lasts until three months after your 65th birthday. If you sign up later, your Part B premiums will increase by 10% for each 12-month period of delay.

“If you do not sign up during your initial eligibility period and you sign up later on, there is a penalty that you have to pay that stays with you the rest of your time you have Medicare,” says Nicole Duritz, vice president for health and family at AARP. If you or your spouse is covered by a group health plan due to your current employment, you need to sign up within eight months of leaving the job or the coverage ending to avoid paying higher premiums.

The age you retire

The age you retire has a huge impact on how much money you can safely spend each year. If you retire at 65 and live until 95, your retirement savings need to provide enough income to finance 30 years of retirement. If you delay retirement until age 70 and live the same number of years, you will only need to pay for 25 years of retirement beyond what Social Security provides.

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As Some Companies Turn to Health Exchanges, G.E. Seeks a New Path by Reed Abelson

CINCINNATI — Although the new federal health care law is designed to help people buying individual policies, even people with employer-provided policies are beginning to see changes in their coverage as companies rethink health care for their workers, discontinuing it in a few cases and redesigning it in many others.

They are motivated by a need to rein in health care costs, which continue to rise faster than overall inflation, but the federal health care law is also changing how some view their obligations to their employees.

Some major firms, like Walgreen, the drugstore chain, are no longer planning to administer health care plans for their employees and are giving those who qualify money to buy insurance on a private health exchange. Aon Hewitt, a benefits consultant that will administer health plans on Walgreen’s behalf, said 18 large employers had signed up so far, including Sears and Darden Restaurants.

But here in Cincinnati, General Electric is taking the opposite approach.

One of the largest employers in the nation, it spends more than $2 billion a year offering coverage to 500,000 employees and retirees and their families. And it is using its considerable clout in places like this — where its giant aviation business gives it a major presence — to work directly with doctors and hospitals to improve care and reduce costs.

“I don’t know anybody who isn’t trying almost everything,” said Helen Darling, president of the National Business Group on Health, which represents employers providing benefits. “We’re going to see a lot of activity in the next couple of years.”

Over the last few years, G.E. has pushed for the creation of so-called medical homes, in which an individual medical practice closely coordinates a patient’s care by having access to all of the patient’s medical records.

In Cincinnati, about 118 doctors’ practices have converted to medical homes, and all five of the major health systems are making their primary care practices move in that direction. G.E. has also pushed for greater transparency of results.

The medical home also appears to resonate with employees. When Mary Farris, a 44-year-old marketing executive for G.E., found herself going to a local urgent care center because she could never get an appointment with her physician, she switched to a practice that had become a medical home.

What strikes Ms. Farris was how much time the doctor and medical assistant spent gathering her medical history and making sure there weren’t additional medical issues. While she came in for a spider bite, the focus was on her well-being as a working mother whose father was seriously ill at the time. “The picture was more on all of me as opposed to one isolated incident,” she said. “Somebody was trying to connect the dots.”

In Cincinnati, there are beginning to be grudging signs of success. Early results are promising: patients enrolled in medical homes had 3.5 percent fewer visits to the emergency room and 14 percent fewer hospital admissions over the four years from 2008 through 2012. G.E. plans to ask an outside firm to do a more detailed analysis.

But employers looking to adapt a similar strategy will find “it’s hard to do,” said David Lansky, the chief executive of the Pacific Business Group on Health, which represents West Coast employers. While “the opportunity is significant,” he said, companies may not have the time or resources to work in too many of their locations, with different hospitals and health plans in each market.

Some companies — Trader Joe’s for example — decided to send at least some employees to the new public exchanges. Trader Joe’s has left coverage for three-quarters of its work force untouched but is giving part-time workers a contribution of $500 to buy policies in the newly created state marketplaces. Because of the employees’ low incomes, the company says it believes many will be eligible for federal subsidies to help them afford coverage.

But a few major employers are taking even more aggressive stances and are trying to reshape how health care is delivered in this country.

They are increasingly looking to make direct connections with health systems, particularly well-regarded institutions that can deliver good care for what can be very expensive back or heart problems. G.E. recently signed an agreement with Hospital for Special Surgery in New York, a high-volume orthopedic hospital, to oversee the care of some employees getting hip and knee replacements. Last year, Walmart contracted with health systems like the Cleveland Clinic, Mayo and Geisinger, among others, to take care of employees who need transplants, heart and spine care. The company says it will soon expand the program to other centers of excellence.

The decision doesn’t always sit well with the home team. In Cincinnati, the UC Health System, which includes an academic medical center that also serves the area’s major source of care for the uninsured, says it would welcome a similar opportunity to provide joint replacements for G.E., but executives say they simply cannot afford to offer significant discounts. “We don’t have the resources to cut deals,” said Dr. Myles Pensak, an executive for UC Health.

G.E. is unapologetic. The company says it will continue to try a variety of approaches until it finds a way to tame health care costs even more than the annual growth rate achieved so far of under 3 percent. “You’ll see many, many experiments across the board,” Ms. Seigel said.

“If we don’t take accountability ourselves for figuring this out, we’re part of the problem,” said Sue Siegel, a senior executive at G.E., who sees transformation of health care both as a business opportunity and a business necessity.

“We have to be involved in the solution,” she said. “We can’t just wait for someone to tell us that it is going to be fixed.”

What distinguishes the effort by G.E. is its direct focus on hospitals and doctors. Companies looking to the private exchanges are largely hoping to save money and want to be freed from the headache of administering health benefits.

In Walgreen’s case, the company says it doesn’t plan to lower its share of its workers’ health care costs but hopes to foster more competition among insurers, leading to better prices and more choice for employees.

In Cincinnati, G.E. took on both a cheerleading and coordinating role. In early 2010, Jeffrey R. Immelt, its chief executive, addressed local business leaders and urged them to think strategically and align their efforts to make more of a difference. There were already significant efforts under way to foster medical homes, for example, and G.E. pushed to find more financing to expand the concept to more medical practices and keep the focus on that initiative.

“The ever-present vigilance of the employers help nudge things along,” said Craig Brammer, chief executive of three area health care coalitions, including the Greater Cincinnati Health Council, which is made up of the area’s hospitals, health plans and employers.

The city’s health systems say they recognize that insurers and employers are increasingly going to reward them for better tracking their patients in and out of the hospital. “We are clearly gearing up to change directions from fee for service for what I’ll call payment for value,” said Will Groneman, an executive vice president for TriHealth, one of the systems.

 

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Zinc affects male fertility

As important as zinc levels are to a woman’s fertility, it may even more vital to a man’s ability to get his partner pregnant. Considered one of the most important trace minerals to date for male fertility, increasing zinc levels in infertile men has been shown to boost sperm levels; improve the form, function and quality of male sperm and decrease male infertility.

When low levels of zinc are found in the male reproductive tract, a variety of disorders may present themselves.

  • Immature sperm: zinc is necessary in the creation of the outer membrane and tail of a sperm. Without it, the sperm can not mature to a stage that gives them the mobility and strength to make the long journey through the vagina, cervix and into the uterus for fertilization to take place.
  • Chromosomal changes: low levels of zinc may also be the reason chromosomal defects in the sperm which could cause a miscarriage even if fertilization and implantation do take place.

Zinc Missing from Today’s Diet Zinc is one of those minerals that are absolutely essential to fertility in both men and women; yet research shows that few people these days get the right amount. One of the reasons why zinc is in such short supply these days is the average diet due to poor soil health, which fails to provide this important mineral. Heating and cooking can also reduce the zinc in foods by 50%. So it is important to eat foods high in zinc in their raw form. The richest source of Zinc is Oysters, but some easy to find and eat sources are raw pumpkin seeds and sesame seeds (look for tahini -sesame seed butter, as well).

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https://clubalthea.com/2016/10/14/your-complete-dna-sequence-will-help-shape-the-future-of-medicine/

Zinc Depletion Linked to Modern Lifestyle

It isn’t just a lack of zinc-filled foods that is sapping our bodies of this all-important mineral. Our modern lifestyle is too. Exposure to stress, pollution, alcohol and even cigarette smoke can also deplete our bodies of important zinc supplies.

Food Sources of Zinc

Making sure to eat enough foods high in zinc on a weekly basis is important. Make sure to try to eat as many zinc sources as you can raw since cooking has been shown to reduce zinc content by at least 50%. Here are the foods highest in zinc, listed in order of concentration:

  • Calf liver

  • Oysters

  • Beef

  • Lamb

  • Venison

  • Sesame seeds

  • Pumpkin seeds

  • Yogurt

  • Turkey

  • Green peas

  • Shrimp

Supplementation to the Rescue If you have tried to eat enough foods high in zinc, but still aren’t sure that you are getting enough, try taking a zinc supplement (our whole food prenatal multi-vitamin has the perfect amount of zinc in it). Take about 15 mg per day under normal circumstances. If your doctor suspects a serious zinc depletion or your also suffer with fibroids, you may need to take as much as 30 mg. to provide your body with the amount it needs. Just be sure to also take a multi-vitamin containing copper (especially if using a higher zinc dosage), since zinc can cause a copper deficiency in some people.

Adding more zinc to your system may not guarantee a pregnancy, but it sure can help to ensure that you have all of the minerals your body needs to produce strong eggs and sperm and is prepared as best as it can be for the job of building a baby ahead.

Iron and zinc interactions in humans

Center for Food Safety and Applied Nutrition, Food and Drug Administration, Washington, DC 20204, USA. pvw@cfsan.fda.gov

Abstract

Iron deficiency is the most common nutritional deficiency in the world.  Zinc deficiency is associated with poor growth and development and impaired immune response. Several Third World countries are taking measures to increase the dietary intake of iron and zinc with fortification of foods or dietary supplements. Several studies showed that high iron concentrations can negatively affect zinc absorption in adults when these trace minerals are given in solution. However, when iron and zinc are given in a meal, this effect is not observed.

Solomons postulated that the total amount of ionic species affects the absorption of zinc and that a total dose of >25 mg Fe (iron) may produce a measurable effect on zinc absorption.

This could occur if iron supplements are taken with a meal, and iron experts recommend that iron supplements be taken between meals. Recent studies using stable isotopes showed that fortifying foods with iron at current fortification amounts has no adverse effect on zinc absorption. There are 5 zinc salts listed as generally recommended as safe (GRAS) by the US Food and Drug Administration for food fortification. From 1970 to 1987, the total amount of zinc salts used in food continually increased, with zinc oxide and zinc sulfate showing the largest increases. Twelve iron sources are listed as GRAS; elemental iron has become the source of choice because it is less expensive to produce and has fewer organoleptic problems. Use of ferrous fumarate is also increasing.

(J Nutr 1986;116:927-35)

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