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| Individual mandate seen as most vulnerable part of health care law Jordan Rau, Kaiser Health News WASHINGTON -- When Barack Obama ran for president in 2008, he insisted the nation could fix its health care system without requiring everyone to carry insurance. As the Supreme Court prepares to weigh in on the health care law, Obama is facing the possibility that he may have to make good on his campaign claim. Experts consider the requirement to hold insurance, known as the individual mandate, to be the most legally vulnerable part of the 2010 law. The administration argues that the law's main goal of providing health coverage to 30 million additional Americans could not be achieved without the mandate because too many healthy people would refuse to obtain insurance, leaving primarily sick people in the insurance pools and driving up premium costs. Obama came around to this viewpoint after he was elected. There are ways that Obama -- if he's re-elected -- might be able to salvage the law even if the court strikes down the individual mandate but leaves the rest intact, health policy experts say. These fixes would create financial incentives for people to not delay enrolling in insurance. One such approach would be similar to what happens in Medicare's Part B program, where people who wait too long to sign up for physician coverage must pay higher premiums. Another tactic would exempt insurers from having to cover pre-existing conditions for several years for consumers who delayed obtaining coverage until illness struck. "It's a simple, elegant policy solution: boom, bang, done," said Robert Laszewski, a consultant and former insurance executive. "That's enough protection for the health insurance pool." But those changes would need congressional support, which is unlikely unless Democrats gain control of the House and a filibuster-proof majority in the Senate. Absent federal legislation, experts say the Obama administration would need to forge a close alliance with insurance companies if it wants to prevent the overhaul from falling apart. Insurers have reason to cooperate, too, even though Democrats vilified them during the 2009 debate over the law, said Len Nichols, director of the Center of Health Policy Research and Ethics at George Mason University in Fairfax, Va. That's because the court might leave intact parts of the law requiring insurers to cover all applicants and not charge those with medical problems much higher rates -- a financial nightmare for insurers. The administration has asked the court to strike those provisions if it invalidates the mandate. "Insurers need this to work, which is why I always said if we can get through this election, they're going to be our best friends," Nichols said. Joseph Antos, a health care expert at the American Enterprise Institute, a conservative think tank in Washington, predicted the administration and insurers would push hard to enroll as many people as possible, using salesmanship rather than compulsion. "I can see a second-term Obama administration bringing in insurers early on, saying, 'Ladies and gentlemen, this is still your job,' " said Antos, who nonetheless doubts the law will succeed regardless of what the court decides. Antos said the administration also could run public service announcements, talking about the new opportunities for people with lower incomes to get federal financial assistance to buy insurance. "What they will hear in the PSAs is there's insurance available, you should sign up for it, protect yourself, protect your family," Antos said. Even without Congress, the states that have been enthusiastically gearing up to implement the law might create their own mandates, similar to what Massachusetts established. Eleven states -- including California, New York, Connecticut and New Mexico -- have asked the justices to uphold the law. Overcoming political hurdles in state legislatures might be easier than in Washington, as insurers are often formidable lobbies in the states. The consternation over the individual mandate stems from the fact that it is intertwined with all the other parts of the health care law. Under the law, most employers will be required to offer coverage to their employers. Very low-income people who aren't covered in their workplace would be covered through Medicaid, the joint federal-state health program to the poor. (The Medicaid portion of the law is also being challenged before the court.) Everyone else would be required to buy policies directly from an insurer, and the federal government would help subsidize the premium cost for people making up to four times the federal poverty level, which would be $92,200 for a family of four under the current guidelines. Insurers would have to take all comers, regardless of their health status, and would be limited in how much more they could charge the very sick. But keeping the premiums affordable -- for both individuals and the government -- hinges on making sure healthy people enroll in insurance, too, contributing premiums that are above what they consume in health care. Hence the argument for a mandate. "If you talk to insurance companies, they will tell you the hardest thing they do is encourage young, healthy people to buy coverage," said Alissa Fox, a senior vice president at the BlueCross BlueShield Association. "If the mandate's not there, you need to go back to the drawing board." Experts don't agree on how badly the law would be hobbled without the mandate to buy insurance. Some economists have estimated that the number of people getting insurance would be reduced by fewer than 8 million people. That's because the law allows people to ignore the mandate if they pay a penalty -- just $95 in the first year -- or don't earn enough to pay for insurance. Other economists have predicted that without the mandate, as many as 24 million people will go without coverage -- two-thirds of the number the law aimed to help cover. There's also wide disagreement over how much the absence of healthy people in the insurance pools would drive up premiums in the new insurance exchanges created for small businesses and individuals who don't get coverage from their employers. Predictions range from premium increases of 9.3 percent to 27 percent beyond what it would cost with the mandate, according to a recent report by the RAND Corp. For now, many advocates of the law say they're not worried. "Most of us who supported the individual responsibility provisions feel the court is going to sustain it," said Ron Pollack, executive director of Families USA, a nonprofit group in Washington. "There's no urgent need to define an alternative course at this point." ======== Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. 2012, Kaiser Health News. Visit Kaiser Health News on the Web at http://www.kaiserhealthnews.org/ Print | Comment | Tweet It | Facebook It | | Sponsor Everybody Hates DietingFREE REPORT: Separate 'Fat from Fiction' and Finally Lose Weight FAST!
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as you discover the 7 hidden truths about weight loss that hold back 98% of dieters Lose Weight Now - Click Here and Get Your FREE Copy TODAY | New guidelines on treating those with HIV developed Meredith Cohn, The Baltimore Sun Some leading AIDS experts have issued the first guidelines aimed exclusively at getting those newly diagnosed with HIV into treatment and keeping them in it. Thirty one international experts, including three Johns Hopkins faculty members, used 325 studies involving tens of thousands of people infected with HIV to develop the guidelines for the International Association of Physician in AIDS Care. HIV, which infects about 50,000 Americans a year, is now treatable. More than a million people are believed to be living with HIV. But that doesn't mean everyone is getting the care they need -- about two-thirds have never use the most effective antiretroviral drug therapy, only 59 percent continue the therapy and less than a third have suppressed or nearly suppressed their disease. "Clearly, there is lots of room for improvement in how we, as care providers, can get new patients into treatment and help them adhere to the often strict drug regimens needed to suppress the viral disease and prevent drug resistance," Dr. Larry W. Chang, a guidelines co-author and an assistant professor at Johns Hopkins, said in a statement. The guidelines were published online in the Annals of Internal Medicine. And Chang, an infectious-disease specialist, said they were important to save the lives of HIV patients. He said those who miss their follow-up care within the first year of receiving treatment tend to die at twice the rate of those who stay with the regimen. Those who suppress their virus are much less likely to give it to others, making the guidelines an important prevention tool as well, say the researchers. Strategies may involve helping the newly diagnosed navigate services available and finding aid for them, having someone call to follow-up about medications or developing an automated system to alert pharmacists or physicians when prescriptions aren't filled. Reducing the number of pills needed would also be beneficial, as would one-on-one counseling, the guidelines say. The group plans more research and an accredited, online medical education program for health care providers. ======== (c)2012 The Baltimore Sun. Visit The Baltimore Sun at www.baltimoresun.com Print | Comment | Tweet It | Facebook It |  Avoid the ER with advice from emergency room doctors Nancy Churnin, The Dallas Morning News You can't prevent every trip to the emergency room, but simple steps can keep you safe -- or keep you alive when the worst happens. Americans made more than 119 million visits to emergency rooms in 2006, according to the National Hospital Ambulatory Medical Care. Among the most common causes cited by the Centers for Disease Control and Prevention are trauma, abdominal pain, chest pain, fever and acute upper respiratory infection. To find out how to cope with those issues, we turned to experts. To help you keep out of the ER, they say you should be getting ongoing care from a primary physician who may be able to catch small problems before they escalate. At the same time, they echo the position of the American College of Emergency Physicians: Don't hesitate if you are experiencing bleeding you can't stop, gaping wounds, breathing troubles, chest pain, extreme pain, vomiting that will not stop, extremely high fever or suicidal thoughts. In addition, they note that the danger signs for children sometimes vary from those for adults; parents should consult with their pediatricians for symptoms that warrant an ER visit, such as any fever in a baby less than 3 months old. When it comes to preventing and coping with the most common ER problems, here's the advice we received from Dr. Matt Bush, Medical City Dallas Hospital's Medical Director of Emergency Services; Dr. Ketan Trivedi, emergency department medical director at Methodist Mansfield Medical Center; and Dr. Halim Hennes, medical division director of pediatric emergency medicine at Children's Medical Center. Trauma Prevention: Use bike helmets, seat belts and motorcycle helmets when you ride. Watch children in grocery carts to make sure they don't fall. Be wary of sharp objects. Practice safety measures around swimming pools. Before heading to the ER: Immobilize broken arms and legs with a straight object wrapped alongside the bone with a bandage. Create a sling for an arm with a large cloth pinned with a safety pin over the shoulder. Put an ice pack on any area that is swelling. Stop bleeding with pressure. Apply gauze and wrap the bandage around the gauze. Be aware that anyone taking blood thinners is at increased risk for excessive bleeding and should share that information with the ER staff. Know the signs of concussion and get checked out immediately if the person shows signs of headache, nausea, confusion or slurred speech after hitting his head. Use CPR immediately on someone who doesn't have a pulse. Each second without oxygen can cause permanent damage to the organs. Chest pain Prevention: Maintain a healthful lifestyle, and don't be a weekend warrior who exercises inconsistently. See your family practitioner regularly and be aware of your stroke and heart attack risk. Sweating and shortness of breath are red flags for a serious problem. Before heading to the ER: Call 911 and go in an ambulance, where technicians can help if your condition worsens. Baby aspirin helps thin the blood, which can avoid clots in most cases but can make things worse if the problem is aortic dissection, or bleeding of the main artery from the heart. Abdominal pain Prevention: Make good food choices, because abdominal pain can be caused by indigestion. If it is, over-the-counter stomach medication may offer relief. Pain can also be caused by food poisoning, appendicitis, diverticulitis, inflammation or colitis. Expectant mothers should ask about a possible ectopic pregnancy. If a head injury is involved, let the ER staff know immediately, as this could be a sign of a fatal blood clot. Before heading to the ER: If you're vomiting, stay hydrated. Drink a half-ounce of clear liquid every 15 minutes and continue as long as it stays down. Take ibuprofen and aspirin for pain and fever as needed. Respiratory difficulty Prevention: Be aware of triggers for breathing problems -- smoke or allergies -- and avoid them if possible. People with asthma and chronic obstructive pulmonary disease, or COPD, are at the greatest risk for respiratory difficulty. If you have signs of bronchitis, see your family practitioner before it leads to pneumonia. Before heading to the ER: People with breathing conditions should use an inhaler and go to the doctor immediately for treatment. Stay calm, as hyperventilation can aggravate the problem. High fever Prevention: Avoid germs by washing hands frequently and not sharing drinks or utensils. Cough into your sleeve rather than your hand. Use hand sanitizers. Check with your primary care physician to make sure you are up to date on vaccinations. Before heading to the ER: Babies younger than 3 months, senior citizens, cancer patients undergoing chemotherapy, patients taking steroids and people with a weakened immune system should go to the hospital with any fever, says the American College of Emergency Physicians. Danger signs for otherwise healthy people can be a fever of 104 degrees Fahrenheit or higher, a fever that lasts for more than four to five days, trouble breathing, a change in behavior, headache or neck stiffness. Be alert to exposure to bacterial or viral infections if the person is not vaccinated or has been recently exposed to possible parasites or bacteria in the water. Bacteria can cause potentially fatal infectious diseases if they get into cuts and wounds. Wash open or infected areas well with soap and water and apply antibiotic ointment and bandages. Bring fever down with acetaminophen or ibuprofen and stay hydrated. Is it an emergency? Even ER doctors find themselves rushing to the hospital sometimes. Trivedi recalls being at a play with his wife and three children when the youngest, who was 2, started playing with his wife's purse. "One minute she had a quarter in her hand and the next minute it disappeared," he recalls. "I asked her, 'Where is that quarter?' and she pointed to her mouth." The American Academy of Family Physicians advises taking a child who has swallowed a battery or something sharp or metal like a coin to a doctor immediately. Even though most small objects will pass through the gut without causing problems, things can get stuck in a child's windpipe that could prove dangerous even in the absence of obvious symptoms such as vomiting, gagging, drooling, not eating, stomach pain, coughing or wheezing. Happily, the X-ray at the ER showed that the coin passed safely through his daughter's system. But Trivedi doesn't regret the trip. "Better safe than sorry," he says. FIRST-AID ESSENTIALS FOR HOME AND CAR The national Poison Control Center number, 1-800-222-1222, which will route you to your local poison control center. Bandaging supplies (skin cleanser, antibacterial ointment, bandages, butterfly bandages for lacerations) Tweezers (to remove splinters) Aspirin (regular for fever and baby aspirin for chest pains) Antihistamines for allergies Ibuprofen as an anti-inflammatory medication Acetominophen as a fever reducer Ice pack for swelling Clean T-shirts for larger wounds or to use as a temporary tourniquet or sling; a safety pin can help secure the cloth over the shoulder. Skin glue (for small cuts) Note: check expiration dates on all medications regularly. SOURCES: Dr. Matt Bush, Dr. Ketan Trivedi, Dr. Halim Hennes SPECIAL ADVICE FOR PARENTS: Don't smoke. Second-hand smoke irritates the lungs of younger children and makes them more susceptible to infection. Even if you go outside to smoke, the smoke may still be in your clothes and in the car. Keep the top of sippy cups and bottles clean. These are often overlooked germ collectors. Toss the trampoline. They put kids at risk for head, spine and limb injuries. Don't leave kids alone in or near water for a second. Most accidents happen when caretakers run to the phone. Lock up pills, poisons and choking hazards. A trip to the grandparents' house can prove dangerous if medications and cleaners are left in a toddler's reach. Choking is a common cause of injury and death in children under 5, according to HealthyChildren.org. Safety pins, toys, coins, broken balloons, batteries and small, smooth foods such as peanuts, raw vegetables and hot dogs can put a child at risk. SOURCE: Dr. Halim Hennes ======== (c)2012 The Dallas Morning News. Visit The Dallas Morning News at www.dallasnews.com Print | Comment | Tweet It | Facebook It | Red meat mortality study leaves many carnivores unfazed Donald Bradley, McClatchy Newspapers Tell people seatbelts save lives and most buckle up. Tell them cigarettes kill and smoking rates go down. But new warnings about red meat don't seem to cry out with the same urgency. Phil Neff of Lee's Summit, Mo., heard about the new study early Tuesday, and at noon he was sitting in Arthur Bryant's BBQ chomping down a beef and pork combo. "I'm having my meat, I don't care," said Neff, 50. His buddy across the table, Gary Cowen, 52, in town from Chicago for the NAIA Tournament, with mouth full held up two fingers. Swallow. "Second time in 12 hours," he said, referring to their barbecue intake. The new study released by the Harvard School of Public Health found that eating red meat -- any amount and any type -- appears to significantly increase the risk of premature death. The long-range study examined the eating habits and health of more than 110,000 adults for more than 20 years. For instance, adding just one 3-ounce serving of unprocessed red meat to one's daily diet was associated with a 13 percent greater chance of dying during the course of the study. Even worse, adding an extra daily serving of processed red meat, such as a hot dog or two slices of bacon, was linked to a 20 percent higher risk of death during the study. "Any red meat you eat contributes to the risk," said An Pan, a postdoctoral fellow at the Harvard School of Public Health in Boston and lead author of the study, published online Monday in the Archives of Internal Medicine. Crunching data from thousands of questionnaires that asked people how frequently they ate a variety of foods, the researchers also discovered that replacing red meat with other foods seemed to reduce mortality risk for study participants. Eating a serving of nuts instead of beef or pork was associated with a 19 percent lower risk of dying during the study. The team said choosing poultry or whole grains as a substitute was linked with a 14 percent reduction in mortality risk; low-fat dairy or legumes, 10 percent; and fish, 7 percent. Previous studies had associated red meat consumption with diabetes, heart disease and cancer, all of which can be fatal. Scientists aren't sure exactly what makes red meat so dangerous, but the suspects include the iron and saturated fat in beef, pork and lamb, the nitrates used to preserve them, and the chemicals created by high-temperature cooking. The Harvard researchers hypothesized that eating red meat would also be linked to an overall risk of death from any cause, Pan said. And the results suggest they were right: Among the 37,698 men and 83,644 women who were tracked, as meat consumption increased, so did mortality risk. Almost 24,000 people died in the two studies. Of those, 5,910 were from heart disease and 9,464 from cancer. In separate analyses of processed and unprocessed meats, the group found that both types appear to hasten death. Pan said that at the outset, he and his colleagues had thought it likely that only processed meat posed a health danger. Carol Koprowski, a professor at the University of Southern California's Keck School of Medicine who wasn't involved in the research, cautioned that it can be hard to draw specific conclusions from a study like this because there can be a lot of error in the way diet information is recorded in questionnaires, which ask subjects to remember past meals in sometimes grueling detail. But Pan said the bottom line was that there was no amount of red meat that's good for you. "If you want to eat red meat, eat the unprocessed products, and reduce it to two or three servings a week," he said. "That would have a huge impact on public health." A majority of people in the study reported that they ate an average of at least one serving of meat per day. The American Meat Institute was among the first to dispute the findings. In a statement issued Monday, the industry group criticized the Harvard study for "relying on notoriously unreliable self-reporting about what was eaten and obtuse methods to apply statistical analysis to the data." The U.S. Department of Agriculture says Americans eat less beef today. The intake peaked in 1976 with a per capita consumption of 89 pounds. By 2000, the amount dropped to 64 pounds, as chicken consumption rose swiftly, to 50 pounds. Some of those cautionary reports about red meat must be sinking in. Still, some people seem quite willing to blow off the warnings. Probably in part because you can get a ticket for no seat belt, and most cities have no-smoking ordinances. How bad can red meat be if there's no law against it? And everybody knows someone like Barbara Thornton. She's 83 and had lunch Tuesday at the Gates Bar-B-Q in Kansas City, Mo. "I eat it all the time, don't bother me," she said. Coming out of Bryant's, Tyson Johnson, in town from Nacogdoches, Texas, waved off talk of the study. "Guess what -- everybody's going to die of something," he said on the sidewalk. "I've been eating meat every day for 63 years. And I knew a guy who never ate meat, and I went to his funeral." Back inside, Cowen from Chicago, went philosophical by citing the old saying that you are what you eat. "I don't want to be tofu," he said. Neff used a last fork of meat to chase sauce around his plate. "I don't even know what tofu is," he said. ======== The Los Angeles Times contributed to this report. (c)2012 The Kansas City Star (Kansas City, Mo.) Visit The Kansas City Star (Kansas City, Mo.) at www.kansascity.com Print | Comment | Tweet It | Facebook It | Horoscopes by E-Mail -- With New Forecast Edition Get daily predictions for your star sign with a free subscription to ArcaMax Horoscopes. 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| Source: http://wyld-about-food.blogspot.com/2012/03/health-and-fitness-for-monday-march-19.html
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