Thứ Tư, 25 tháng 2, 2015

Health Care Challenge has moved to a new site

The Health Care Challenge has a new home as part of the redesign of the Observer's website. You can read editor Rick Thames' explanation of that change here.

The move means a new look and a new system for posting comments, which now matches the rest of the Observer's news.  I hope you'll keep reading and keep discussing. Please bookmark the new location: www.charlotteobserver.com/news/business/health-care/health-care-challenge-blog/

We've moved! (Image from charlestongrit.com)

Gallup: More in NC insured, but gains are small

North Carolina went from having just over 20 percent of its citizens uninsured in 2013 to 16 percent last year,  once the Affordable Care Act started offering subsidies to help people afford premiums, Gallup reported Tuesday.

But states that accepted federal money to expand Medicaid for the poorest adults saw bigger gains in coverage, according to the latest report from the Gallup-Healthways Well-Being Index,  which polls a random sampling of adults across the country. The national uninsured rate went from 17.3 percent to 13.8 percent, the lowest in the seven years of the well-being poll.

"Collectively, the uninsured rate in states that have chosen to expand Medicaid and set up their own state exchanges or partnerships in the health insurance marketplace declined significantly more last year than the rate in states that did not take these steps," Gallup reports. "The uninsured rate declined 4.8 points in the 21 states that implemented both of these measures, compared with a 2.7-point drop across the 29 states that have implemented only one or neither of these actions."

North and South Carolina, along with many Republican-led states, neither set up an insurance exchange nor expanded Medicaid. 

As Rose Hoban with N.C. Health News recently reported, bankers and business leaders have been receptive to the argument that expansion would bring financial benefits to the state,  though the state Chamber of Commerce has taken no position. And a coalition of health and anti-poverty advocates argue that expansion would save lives and create jobs. But state legislative leaders remain wary of the costs and complexities of expansion, and Gov. Pat McCrory has said he'll delay any plans to expand coverage until the U.S. Supreme Court rules on a challenge to the ACA.

Thứ Ba, 24 tháng 2, 2015

The Starbucks Method for Primary Care

Whether you like it or not health care financing is transitioning from payment for discrete services to global payment for value. Whether you agree with this trend, or comprehend its meaning, if it has one, is largely irrelevant in the short term. The government of the United States, the Chamber of Commerce, both political parties, all health care stakeholders, and even your own medical associations are fervently supporting, and actively promoting, paying you for value instead of work.

Value is defined by a set of statistical metrics calculated across the spectrum of services you provide, and some that you don’t. So for example, if Starbucks were to be paid for value, they would get say, $2 for a venti latte, plus a fluctuating amount based on the average temperature of their lattes, the ratio of espresso to milk, the percent of air in the foam, the time from door to latte, etc., over a representative period of say 90 days in year one and maybe 12 months in subsequent years. To enable latte valuation, all espresso machines would be fitted with special monitors interfaced to local cash registers and to centralized centers of value. The exact value-based bonus would be calculated by analyzing the statistical distribution of metrics across all coffee shops in the country, adjusted for regional and demographic variation of their clients.

If Howard Schultz would be notified tomorrow morning of a transition to value-based payment for coffee, he would most likely protest loudly, but at the same time he would find a way to get $10 for his lattes while the coffee debates are raging across the nation. And so would every independent coffee shop still in existence. Health care is of course much more complicated than making espresso drinks, but the principle is the same. Unless you find a way to keep your doors open during bad times, you will not be around to enjoy the fruits of your efforts to bring about the good times. Assuming you wish to continue selling coffee, there are two (legal) options to consider: sell fake lattes for less than $2, like they have in every self-respecting gas station, or do what Howard Schultz would do in a similar situation.

The Howard Schultz option for independent primary care could be summarized as the answer to the following question: what do I need to do in my practice, so that I can collect enough revenue to continue providing the excellent care my patients are accustomed to? Below are some suggestions that may allow you to do just that. You could look at these suggestions as encouragement to sell your soul to the devil, or you could look at them as an optimal way for creating enough breathing room for you, and your patients, until common sense prevails. If you are tempted to dismiss this, in view of the recent (partial) success of grassroots efforts to beat back the ABIM MOC, please keep in mind that by and large those who fought ABIM were board certified physicians in good standing. Fighting for a good cause does not mean that you first have to commit financial and professional suicide.

Beginning on January 1st, 2015, Medicare will be paying physicians for chronic care management (CCM) services, if and only if, a certified EHR is used in the practice. This is the first time Medicare is tying payment for a CPT code, to the use of specific technology, and it may very well be a harbinger of things to come. Medicare is essentially stating that unless you buy and use a government certified EHR (not just any EHR), it will refuse to pay you for any work (other than face to face visits) that you do for your chronically ill patients. It is fascinating to note that Medicare acknowledges that certified EHRs cannot help much with CCM services, and you may need other software products for this purpose. Nevertheless you must also purchase a certified EHR.

On February 12th, 2015 the Center for Medicare & Medicaid Innovation Center (CMMI) has announced a new payment model for cancer care, the Oncology Care Model (OCM), modeled after the CCM, but paying four times as much to oncology practices only. The OCM is going to enter pilot phase in 2016, and chances are it will be elevated to an official CPT code shortly thereafter.  Taking the CCM one step further, the oncology care management fee will be paid exclusively to practices that attest to currently mandated meaningful use levels (Stage 2 for now), although meaningful use has practically nothing to do with oncology care.

It is not implausible to assume that these are just the first steps in making collection and dissemination of clinical data, along with kickbacks to the tech and certification industry, a condition for practicing medicine. If you think you can somehow “escape” these mandates by dropping public insurance plans, you should note that the OCM pilot mandates participation of commercial insurance plans in this form of payment. Unlike the puny meaningful use incentives/penalties, both CCM and OCM fees can add up to large amounts of recurring revenues for a complex set of services. If you don’t have a certified EHR, your choices are to either continue performing these services for free, or cease to provide them altogether. Strangely enough, nobody seems to question the legality of such scheme.

Bottom Line

Go ahead and get yourself a (cheap) certified EHR, and use it sparingly if you so desire. Make sure you know how to get all the data out of the EHR, because chances are you will want to dump it when things get better. Keep in mind that even under the best case scenario, technology will not improve overnight. It takes several years to build (or refurbish) a good EHR, and EHR vendors are now operating within a regulatory pay for performance mentality, i.e. studying for the (certification) test and cheating to survive. Even if Medicare drops its ill-conceived meaningful use program tomorrow, it will take time to return to a competitive culture of excellence and customer service, yielding beneficial technology tools for your practice.

It is not likely that value-based payment models will disappear, or be reconfigured to measure benefits to your patients, because there are hundreds of billions of dollars in shareholders profits, and fabulous round trips to Davos, riding on this one simple innovation. It is equally unlikely that physician payments will grow in the near future, and there is every reason to assume that payments will decline sharply, as the system adjusts itself to serving increasing numbers of underinsured poor people. It will be very important for you to strike an optimal balance between keeping your costs down, and increasing your value-based revenues.

Finally, for those insisting that their practice is doing just fine without all this unsolicited advice, this may be so for now. And for a few fortunate physicians, it may be so for long enough to reach comfortable retirement. Perhaps a handful more would be able to extricate themselves from this mess by catering exclusively to the few that need not concern themselves with costs of anything.  Everybody else should find a way to collect $10 for their lattes.

Thứ Sáu, 20 tháng 2, 2015

Managed care groups push N.C. Medicaid reform

A coalition of insurance companies and managed care providers recently launched N.C. Medicaid Choice to lobby for change in the way the state administers the program.

"The Coalition supports legislation that shifts financial risk away from taxpayers by allowing traditional managed care plans, as well as plans offered by health care providers, to compete in the North Carolina Medicaid market," says an announcement posted Feb. 10.

Griffin
AetnaAmerigroup, AmeriHealth Caritas, UnitedHealth Group and WellCare are the founding members. They've hired Taylor Griffin, a political consultant who ran for Congress in the 2014 GOP primary, as point person for the campaign. Griffin, an Appalachian State alum, worked for Sen. Jesse Helms and President George W. Bush before making his own bid for office (he lost to Walter Jones).

Republican leaders of the state House and Senate have talked about the need to reform Medicaid, which has a history of cost overruns, but haven't agreed on a strategy.  Griffin said Thursday his coalition supports the Medicaid Modernization bill,  which would let groups like the ones he represents compete with accountable care organizations run by doctors or hospital, over the Partnership for a Healthy North Carolina bill that turns Medicaid over to only the provider-led groups. 

Both involve the state paying a per-patient fee to groups that take the responsibility for providing care and controlling costs; they turn profit if they come in under budget or take the loss if they run over.  Both, says Griffin, provide incentives to push the kind of preventive care that not only cuts costs but improves lives -- for instance, prenatal care, timely screenings and healthy lifestyle changes. Allowing the established for-profit firms to compete will lead to bigger savings and a quicker roll-out, Griffin said.

A news analysis that ran in the Observer this week noted that in some Republican circles, "Medicaid reform" has become a euphemism for taking federal "Obamacare" money to expand coverage for low-income adults. Griffin said his group is taking no stand on Medicaid expansion in North Carolina. For them, reform is about fixing with the system that's in place, not making more people eligible.

Thứ Năm, 19 tháng 2, 2015

ACA numbers: What's squishy, what's solid?

Early tallies of 2015 participation in the Affordable Care Act exchange are bound to raise follow-up questions,  not only among those who doubt anything President Obama says but those trying to sort out the nuances of a complex system.

The White House was eager to announce a preliminary estimate of 11.4 million sign-ups nationwide.  That includes totals from the 37 states that use the federal marketplace as well as  "preliminary analyses"  of data from state-run markets.  Federal officials say that number is 10 percent over the White House target, with numbers that jumped significantly in the final week.
White House graphic touting tally

As indicated by the  "preliminary" label,  that tally is bound to change.  Some states that run their own markets have granted extensions to the Feb. 15 deadline because of winter storms or system glitches.  Some who hit snarls in the federal exchange on the final weekend got an extra week to finish enrolling.

The tally includes people who selected plans but won't actually pay the premiums.  Kevin Counihan,  CEO of the federal marketplace,  predicts that about 87 percent of enrollments will translate to actual coverage.  That comes to about 9.9 million people.  Obamacare critic Avik Roy noted that 2014 ACA retention translated to 84 percent,  "fairly similar to (the rate) experienced by private insurers in the conventional ... insurance market."

The feds also released totals for the states using HealthCare.gov and major cities within those markets  (read that report here).  We don't yet have a breakdown of new plans vs. renewals for the states,  though Counihan said about 8.6 million of the 11.4 million nationwide,  or 75 percent,  were renewals.  Nor do we have a final count on how many got subsidies,  though a Feb. 9 report pegged North Carolina's total at 92 percent.

Katherine Restrepo,  health analyst for the John Locke Foundation,  notes that while that percentage may be accurate it can be misleading.  Those at the high end of eligibility (up to $95,400 for a family of four) get small tax credits that do little to lower costs, she says.

Roy contends that the White House tally is "deceptive" because it includes an unknown number of people who already had insurance and switched. It's true that the totals don't distinguish between those who had insurance and those who didn't,  though I'm not convinced that the White House and "friendly media outlets" have claimed otherwise.

Finally,  reader Bryan Griffith correctly called me out for not including any specifics in a recent article citing a surge of last-minute enrollments in Charlotte.  Here's what the latest report shows:  The Charlotte metro area got almost 17,000 sign-ups between Feb. 6 and Feb. 15,  or about 12 percent of the total enrollment logged during the 13-week enrollment period.

Thứ Ba, 17 tháng 2, 2015

Unanimous vote to expand N.C. Medicaid? Well ...

Jeff Jackson,  a Democratic state senator representing Mecklenburg's District 37,  knows how to have fun with a snow day.

This morning he posted on Facebook that "Due to inclement weather,  I appear to be the only non-security person in the General Assembly this morning.  I feel like I should hurry up and pass Medicaid expansion.  Anything else while I've got the place to myself?


His constituents  --  or at least his Facebook friends -- got a kick out of that,  with more than 100 comments and 500 likes by 9:30 a.m.  He got a long list of requests,  from raising teacher pay to banning puppy mills and legalizing marijuana.

Around 8:30 a.m.,  Jackson started tallying his accomplishments:

Just came back from the Senate chamber. All votes were unanimous.
Medicaid = expanded. Teachers = paid. Film = jobs. What's next?
This is going to be like "Night at the Museum" except at the end we'll have a stronger middle class.

Sen. Jeff Tarte, a Mecklenburg Republican, later posted that he and several GOP colleagues were there working as well.   "Classic example of Democrats 'misrepresenting the facts,' "  Tarte sniffed  before tipping his hand with an "LOL" and an invitation for Jackson to join him for dinner.

By that time the #JustOneLegislator winter fantasy had gone viral.  Mutual Facebook friend Laura Hehn had a suggestion  --  "Work together and make some positive changes!"  --  and even offered a couple of new hashtags: #JustTwoLegislators or #JustTheJeffs.

Losing health benefits? Study blames recession

If your employer provides health insurance,  you're probably paying more for less  --  and wondering who's to blame.  The Affordable Care Act has contributed to rising costs by mandating certain types of coverage,  allowing many adult children to stay on parents'  policies and levying a 2018 tax on high-cost  "Cadillac plans."

But the trend toward reducing benefits and dropping health insurance altogether was in full swing before the act kicked in this year, according to a recent analysis by the University of Minnesota’s State Health Access Data Assistance Center and the Robert Wood Johnson Foundation.

Before to the recession, the research shows that employer coverage was fairly stable.  Between 2004-05 and 2008-09,  for instance,  North and South Carolina,  like most of the country,  saw no significant change in the percent of employers offering health insurance.  But the rates dropped from 2008-09,  the start of the recession,  to 2012-13.  In North Carolina it went from 53 percent to 47 percent,  and in South Carolina from 54 percent to 47 percent.  Most of that decline has come from companies with fewer than 50 employees.




That's consistent with what I've heard.  For instance,  I wrote last fall about Charlotte's Blue Max Materials,  a small employer,  dropping health insurance in the face of rising costs.  Meanwhile,  the owner of Stafford Cutting Dies bumped up deductibles dramatically to cope with skyrocketing costs for a small-business policy.


“Most Americans still get health insurance through their jobs, but this has been declining for more than a decade,” said Katherine Hempstead, who directs coverage issues at the foundation. “It will be interesting to see how that trend evolves now that there are more opportunities for coverage through the individual market and Medicaid.”

The report includes detailed breakdowns for each state.


Thứ Hai, 16 tháng 2, 2015

Sweet Potato Chocolate Spread

What if I told you that 2 tbsp of this spread provides you with all the vitamin A you need in a day? Sounds too good to be true? Well it isn't. Other than being delicious, sweet potatoes are packed with this super important nutrient that keeps your eyes in good condition and your skin beautifully radiant. Plus this recipe is so simple and quick to make and only requires five ingredients! No excuses!




Ingredients:

2 medium-sized, peeled sweet potatoes (380 g)

3 tbsp melted cacao butter or coconut oil

10 dates (100 g)

2 tbsp cacao or cocoa powder

Pinch of salt


How to:

1. Cube the sweet potato and steam until entirely soft and easy to pierce with a fork, approximately 15-20 minutes.

2. Transfer the cooked sweet potato to a medium-sized bowl, add the remaining ingredients and blend with a hand blender until smooth. This could also be done using a food processor.
3. Spoon up the chocolate spread in a mason jar or any airtight container of your choice and store in the fridge.

Enjoy this spread on peanut butter sandwiches, your oatmeal or eat it straight from the jar with a spoon! (That's what I do...)

Chocolate love from Tilda 

Health care is a massive market…

America is spending $3 trillion on health care every year. Does that number include toothpaste? Surely toothpaste is very important to your health. How about baby powder, diapers, condoms, soap, lip balm, nail clippers, detergents, mops, vacuum cleaners, washing machines, smoke detectors, air filters and air bags? How about everything Nike sells, diet books, your gym membership, bicycles, skateboards, everything Sports Authority carries in its stores, and all Weight Watchers products? And then there is quinoa and edamame, spelt, flax, organic kale chips and those scrumptious gluten-free kelp smoothies. You can also count the entire budget of the EPA, the FAA, the CDC, the FDA and the USDA, and while at it let’s not forget the war on drugs, the war on poverty and the war on terror, and of course education and vacation, sunscreen, traffic lights, firefighters, police and those weirdly bluish ice-melting crystals for your driveway. It sure looks like we are spending all our money on caring for our health.

In America, we spend $3 trillion every year on medical care, not health care. Medical care is what you get mostly from doctors and nurses, mostly in hospitals or clinics, and mostly when you are sick or hurt. Medical care is most often associated with pain, suffering and fear, and is something most people, most of the time, don’t use, don’t need and don’t want. The new thinking says that if we could spend less money on medical care, we could spend more on Bluetooth enabled holographic toothpaste, and that this is a good thing. After all, most of our $3 trillion is spent on a small fraction of sick and elderly citizens, most of whom will never get better anyway. Wouldn’t it be more fun to spend our money on nice things for the majority who is basically healthy, so they can be even healthier, and perhaps forever healthy?

Also $3 trillion is too much money to spend on regular people, who truth be said can’t really afford it anymore, because according to none other than J.P. Morgan, “US labor compensation is now at a 50-year low relative to both company sales and US GDP”, while “[corporate] profit margins have reached levels not seen in decades”, and miraculously “reductions in wages and benefits explain the majority of the net improvement in margins” [emphasis in the original]. When your wages and benefits are at a 50 year low relative to GDP, courtesy of the general plutonomy, and your medical care expenses are at an all-time high relative to the same GDP, courtesy of the medical-industrial plutocrats, you have two basic choices. Start a revolution, or let yourself be wooed by the thieves. Revolutions are hard and very inconvenient for consumers, so sit back and be wooed.

Medical care is sick care. Sick care sounds depressing, and sick care is expensive. Sick care is what happens where health care fails. Health care is cheap and pleasant. Better health care will obviate the need for sick care. Ergo, we should invest heavily in health care right here, right now, and quit funding exorbitantly priced products and services for sick care, because soon, very soon, there will be no sick people. For some, midlife crisis means buying a red Porsche, for Google owners it means spending $1.5 billion on the fountain of youth. For Peter Thiel, it means actually becoming immortal. For CVS pharmacies it means changing the company name to CVS Health. For Apple it means releasing a plebian version of the fountain of youth called simply Health. And for the rest of us, it means paralyzing fear.

The best is behind us. The American Century is over. Ebola is going to kill us all, and if not Ebola then the measles will. And if not disease, then surely we will fall prey to the toddler invasion from Guatemala, or the long-range nuclear missiles of the Russian Empire, or the marauding bands of sociopaths roaming the Arabian desserts in Toyota pickup trucks, raping and decapitating everybody in their path, not to mention the global ice age descending on Boston with the fury of a theory scorned. History teaches us that every great nation has to fail and every governance model is destined to perish and all societies will eventually disintegrate. Today is our turn to die. But then the drums begin to bang and the stars fall from the sky, the moon turns red with blood and the trumpet sounds its call.

Behold the vision of the saints as they go marching in, masterfully weaving the Narcissistic obsessions of the young and healthy with the helplessness and impotence imposed on the marginalized masses. An Apple a day keeps the doctor away. We will solve all your medical care problems caused entirely by your failure to be healthy. We will manage your wellness, your food, your activity, your thoughts, your desires and your disillusion, and we will make sure that you function within optimal parameters. We will take preventive actions at the very first sign of malfunction, long before it becomes sickness or injury. We will keep you, your children and your children’s children, healthy and productive. This is our solemn promise to you and we may even keep it, if you obey us and always do right. As the sign that you are keeping this promise, you must strap this bracelet on every man and boy in your family, and yes, of course dear, womenfolk too.

Here is a free app if you agree to swallow our drugs, and here is a free test if you let us decide what to do with the results, and here is a free toaster if you get a mortgage, and here is free health insurance letting you have any doctor or hospital you want, as long as it’s the one we picked for you. Here is your freely elected representative, programmed to say what you want to hear, on a soft bluish background because we know from your genomic sequence that bluish colors engender your trust in us. No sweetie, we don’t think you’re stupid, but you are weak and frightened. We are just trying to do what’s best for you and we appreciate your input, your tweets, your blogs, your amusing comments, your die-ins and even a little arson and looting, if done in good taste. One day you will be grateful for our guidance and the limits we are setting for you now. Or maybe not, but by then you’ll all be dead anyway, so frankly darling, we don’t give a damn.

Thứ Sáu, 13 tháng 2, 2015

So you got insurance. Will it help?

As the 2015 push for health-insurance enrollment winds down, the next challenge grows ever clearer:  Insured people who can't afford medical care.

The New York Times Sunday Review carried an article titled  "Insured, but Not Covered."  Reporter Elisabeth Rosenthal explores trends in insurance and health care that are leaving people with insurance unable to find doctors or pay bills.

Her conclusion:  While the Affordable Care Act has brought coverage to roughly 10 million Americans and eliminated  "some of the more egregious practices of the American health insurance system that left patients bankrupt or losing homes to pay bills,"  the law has also adopted policies that "may in some ways be undermining its signature promise:  health care that is accessible and affordable for all."

A key culprit is the boom in high-deductible policies,  which allow employers and private buyers to reduce premiums by agreeing to much higher out-of-pocket costs.



For instance,  HealthSherpa recently sent along an analysis of  14,000 North Carolina health insurance purchases made on the company's web site,  which provides an alternative path for buying subsidized plans on the ACA exchange.  Those buyers had an average household income of about $20,400 and bought policies that averaged $70 a month for the buyer,  with the government kicking in an average of $381 a month.

But the average deductible per enrollee was $3,969 and the average out-of-pocket max was $5,745.  Can you imagine anyone making less than $21,000 a year being able to save $4,000 to $6,000 to cover those costs?  Reality is,  even paying a couple of hundred dollars may be daunting enough to discourage people from going to the doctor's office.

A recent report from The Commonwealth Fund showed that the number of people skipping care because of costs declined in 2014,   the first time since the question was added to the fund's health insurance survey in 2003.  But while the numbers fell significantly compared with 2013,  the year before the ACA took effect,  the report estimates that 66 million Americans,  or 36 percent of adults, still skipped an office visit,  test,  treatment or prescription because they couldn't afford it.
ontinue reading the main storyBut by endorsing and expanding the complex new policies promoted by the health care industry, the law may in some ways be undermining its signature promise: health care that is accessible and affordable for all.

Thứ Ba, 10 tháng 2, 2015

Health activist moves from Obama's home to Tar Heel state

One of the best-known health care activists from President Obama's home state has recently moved to North Carolina.

Jim Duffett,  longtime director of the Illinois Campaign for Better Health Care,  relocated to Chapel Hill in August,  drawn by milder winters and job opportunities for his wife,  an oncology nurse.  In Illinois he spent 30 years working for affordable care and patient rights,  eventually building a coalition of 300 groups representing health care,  faith,  labor and various communities.
Duffett

"One fond memory is having had the honor of working with Obama on health care reform in Illinois during Obama's years as a (state) senator,  and now,  'knowing he is the president and still knows you,'  "  Duffett said in an interview with The  (Champaign)  News-Gazette.

Duffett,  a proponent of a single-payer insurance system,  has connected with the NAACP-led Forward Together Moral Movement and is looking for work in advocacy here.  He says he's still getting up to speed on North Carolina's health care scene,  but sees some similarities with his old turf.  Both states have powerful political opposition to Medicaid expansion,  he said,  and Illinois'  2013 approval was hard-fought and narrowly won.  In North Carolina,  he says,  he hopes to build alliances with some of the hospital,  medical and business interests that united with more traditional anti-poverty groups in Illinois.  "There's definitely going to have to be a bit more base-building,"  he said,  though the Moral Monday protests  "are definitely galvanizing folks."


Thứ Hai, 9 tháng 2, 2015

Burr leads push to repeal and replace Obamacare

U.S. Sen. Richard Burr is taking a lead role in the latest push to replace the Affordable Care Act with a more market-driven approach to health reform.  The North Carolina Republican joined two other committee chairs last week in introducing a new version of a prior  "repeal and replace" plan.

Burr
The Patient Choice,  Accountability,  Responsibility and Empowerment Act  (Patient CARE) would repeal the coverage mandate that's part of the ACA and revamp the subsidized marketplace that helps low-income people buy health insurance.  The act,  co-authored by Sen. Orrin Hatch of Utah and Rep. Fred Upton of Michigan,  would use the marketplace to replace Medicaid expansion,  allow interstate insurance purchases and revamp the tax break for employer insurance.

Avik Roy,  author of a leading plan to reform the ACA piece by piece,  offers an in-depth look at how the new Patient CARE Act compares with the prior version and with his own plan.  He's a fan of the Burr-Hatch-Upton bill,  even though he contends his own plan is more practical because it doesn't require repeal of the ACA.

"Both plans would offer better health outcomes for the poor,  by allowing those on Medicaid to obtain tax credits for the purchase of private health insurance and health savings accounts,"  Roy writes.  "Mostly importantly,  both plans would cover more people than Obamacare,  because they would drive down the cost of health insurance for those who can't afford it today."

For a more skeptical take,  read this piece by the Huffington Post's Jeffrey Young and Jonathan Cohn.


"Republicans promote these changes as increasing  'choice'  and  'flexibility'  in insurance,  claiming that they will result in less federal spending and that younger adults will pay lower prices,"  they write.  "But each of these proposed changes would carry other consequences as well.  Policies without full benefits,  including  'junk'  plans and mini-med policies,  would return to the market.  The same pricing practices that reduced premiums for 25-year-olds would jack them up for 60-year-olds,  putting insurance out of reach for many older Americans."

The Brookings Institution also offers a pro and con perspective.  Stuart Butler gives the plan  "two cheers"  as a viable plan for  "addressing the impasse over the ACA and achieving health coverage goals that are widely shared,"  while Henry Aaron says it moves in the wrong direction by creating more holes in the health care system.

Chủ Nhật, 8 tháng 2, 2015

Single white Southerners: ACA benefits may await

People who are eligible for aid paying out-of-pocket medical costs are most likely to be white, single and living in the South,  according to a new report from the Robert Wood Johnson Foundation and the Urban Institute.

Most people know that the Affordable Care Act provides tax credits  (aka subsidies)  to help low- and moderate-income people buy health insurance.  Less known,  the authors say,  is that people earning up to 200 percent of the federal poverty level  ($29,175 for a single person)  can also get help paying out-of-pocket expenses,  a major concern in an era of high-deductible policies.

"This benefit seems to fall off the radar sometimes,"  said Katherine Hempstead,  director of coverage for the Johnson foundation.  People need to choose a silver plan to qualify for that help, she added.  Those who choose a bronze plan for the lower premiums may end up worse off when they're hit with higher out-of-pocket bills.

The study looks at who is expected to fall into those income ranges in 2016,  though it's obviously timed to remind people about enrollment before the Feb. 15 deadline for 2015 sign-ups.  The authors broke the country into four regions and found that almost half of the eligible people live in the South  (a zone that includes such states as Texas,  Louisiana and Oklahoma,  as well the Southeast).

That's probably because many of those states,  including North and South Carolina,  haven't accepted federal money to expanded Medicaid.  In states that did,  people who fall below 138 percent of poverty qualify for Medicaid.  In non-expansion states,  those between 100 and 138 percent qualify for aid on the exchange.  Many who make less than the poverty level fall into the Medicaid gap and can't afford insurance.

Single people without children accounted for the biggest block by family status  (48.9 percent),  and non-Hispanic white people made up 60 percent of the eligible people.

The study doesn't account for how many people within the income brackets may have other types of  insurance and how many are already be getting the subsidies.

Creamy Dreamy Peanut Butter-Blueberry Sundae





Ice cream:

- 3 ripe bananas, sliced and frozen (300-330 g)


- 3-4 tbsp almond milk

- 1 heaped tbsp Arctic Berries Blueberry Powder

- 1 pinch vanilla powder or extract

Peanut Butter Sauce:

- 1 tbsp peanut flour (or peanut butter)


- 1 tbsp almond milk

- 1 pinch sea salt

Optional:

- Toppings such as mulberries, coconut chips or raw cacao nibs


How to:

1. Start by making the peanut butter sauce: in a small bowl combine the ingredients for the sauce with a fork until you're left with a thick yet runny sauce. Set aside while you make the ice cream.

2. Place all the ice cream ingredients except for the almond milk in a food processor or high speed blender and blend on high*. Blend for approximately 60-90 seconds or until the frozen banana slices have all been broken down to tiny pieces. Stop to scrape down the sides if necessary.
3. Carefully remove the top cap from your blender and slowly pour in the almond milk while blending. Blend on high until smooth and again, stop to scrape down the sides if you need to. Be patient and don't add more liquid unless you really have to. The ice cream will be much creamier and not as runny this way.
4. Spoon the ice cream up in two bowls and drizzle generously with the peanut butter sauce. Top with whatever you desire and eat immediately before it melts! (And feel free to just have it ALL for yourself. That's what I did.)

*I find this the most effective way to get a creamy, completely smooth ice cream but if it seems too complicated to you, simply place all the ice cream ingredients in the blender/food processor and blend until smooth.

Thứ Sáu, 6 tháng 2, 2015

Berry-Boosted Blueberry Jam (Naturally Sweetened)

There's something oddly comforting about jam. That sweet, slightly sour taste adds another dimension to basically any carb-y meals. On top of a steaming hot bowl of oatmeal is how we usually enjoy our jam here in Sweden but I have always loved to spread a thick layer of raspberry preserves on top of a crispy, golden brown slice of toast. Mhm. And I know I just said raspberry even though this recipe specifically calls for blueberries. Confession: I didn't like blueberries as a kid. I loved spinach but not blueberries. Yes, I was weird. Moving on.



I must say I'm very pleased with this recipe. It's thick, just like jam is supposed to be. Don't want any of that runny, slimy stuff, no thank you. So it's thick, packs a punch of blueberry flavour only rounded off by a hint of vanilla. I even got my mom hooked on it so now it's a battle against time to have as much as possible for myself before she eats it all up!




Also, I finally got to use a jar from the collection featured throughout this post. To say that I have an obsession with jars is an understatement. This recipe makes one small jar but if you feel like you're likely to finish it soon after making, feel free to double the recipe. You could probably even freeze some for later if you wanted to, even though I haven't tried this myself yet.

Finally I want to point out that this jam is even more nutrient-dense than your average Homemade-healthy-jam all thanks to the Arctic Berries powders! I added some of the blueberry powder and some of the sea buckthorn powder in this but combine them however you want for your own personal touch! Hope you enjoy the recipe!


Berry-Boosted Blueberry Jam

-1/2 lb (225 g) frozen or fresh blueberries

- 6-8 fresh dates (75 g)

- 1/2 tsp pure vanilla powder

- 1/2 tbsp  any Arctic Berries Powder (I used the Sea buckthorn and blueberry powders)

- 1 tbsp chia seeds

How to:

1. Place the blueberries in a small sauce pan and slowly thaw them over medium heat.

2. Meanwhile, pit the dates and put them in a small bowl. Blend the dates with a hand blender until smooth and set aside.
3. Once the berries start to release their juices, bring it up to the boil and let boil for about a minute.
4. Remove the blueberries from the heat and stir in the date paste, vanilla powder and Arctic berries powder(s). If the date paste feels very dense and hard to incorporate into the berry mixture, start by transferring a few tablespoons of blueberry juice into the bowl with the date paste and mix the two to make it a bit looser in consistency.
5. Lastly, stir in the chia seeds and make sure they're evenly divided throughout the jam.
6. Spoon the jam up in a glass jar, seal it and let sit on the countertop to cool off before putting it in the fridge.



My favourite way to eat this jam - thinly spread on top of a rice cake.



Best Granola Ever (no oil!)

Prepare yourselves for the crunchiest, sweetest, most delectable granola ever! Though you could never tell from how they taste, these caramel-ly clusters are 100% refined sugar-free and contain no added syrups or oils whatsoever! That's just how we do it around here. ;)



The added nutrient-boost from the sea buckthorn powder gives this granola an extra umph, a je-ne-sais-quoi that is hard to beat. I know that I'm going to add this beautiful orange powder to many more recipes from here on out and after tasting this granola, I hope that you are as well.


Sea Buckthorn & Buckwheat Granola

1 cup raw buckwheat groats (175 g)

1/2 cup quinoa pops (15 g)

1/2 cup raw almonds (75 g)

14 dates, pitted (160 g)

2 tbsp Arctic Berries Sea Buckthorn Powder

2 tbsp water

How to:

1. Pre-heat the oven to 130C.
2. Chop the almonds coarsely and pale them in a large bowl along with the buckwheat groats and quinoa pops.
3. In another, smaller bowl, blend the pitted dates, water and the sea buckthorn powder with a hand blender until completely smooth.
4. Transfer the date paste into the bigger bowl and mix well with the grains and almonds until you have a chunky 'dough'.
5. Bake in the oven for 35 minutes. Remove to stir around every ten minutes to prevent the clusters from burning!
6. To make sure the clusters stay crunchy, leave them in the oven overnight to dry out, preferably with the oven lamp on.
7. Store in an airtight container and enjoy on top of your smoothies, oatmeal, banana ice ream or anything really!







NC Medicaid battle: Hard numbers and human stories

The groups fighting for North Carolina to expand Medicaid this year are taking a two-pronged approach.

In news conferences in Charlotte and Raleigh this week,  the N.C. Medicaid Expansion Coalition urged people to share their stories at NCLeftMeOut.org.  They're looking for personal tales from people like Charlotte's Dana Wilson,  whose multiple sclerosis limits her to working a few hours a week at an antique shop.  Wilson doesn't earn enough to qualify for subsidized health insurance and isn't eligible for Medicaid.

Charlotte news conference

But the coalition,  led by Action NC and Progress NC,  is also taking a more hard-nosed approach, focusing on jobs and tax revenue that would be generated by accepting the federal money to expand Medicaid coverage.

A recent report by George Washington University's Milken Institute School of Public Health,  commissioned by the Cone Health Foundation and the Kate B. Reynolds Charitable Trust,  projects that if state lawmakers were to approve expansion this year,  the decision would generate about 43,000 jobs by 2020.  About half would be in health care,  the report says,  with the rest spread among sectors ranging from construction to retail "as health care workers use new income to pay their mortgages, buy groceries, pay taxes and so on."

"At county levels, if Medicaid is not expanded by 2016, Mecklenburg and Wake Counties would create about 4,500 fewer jobs each by 2020,"  the report says.  "Mecklenburg County’s total economy (gross county product) from 2016 to 2020 would be almost $1 billion lower."


"Lawmakers like to talk about fiscal responsibility,"  Wilson said in Charlotte Thursday.  "It's just common sense."


The Affordable Care Act includes money to expand Medicaid in all states  --  and levies taxes that everyone is paying,  regardless of whether the state accepts the money or not.  A handful of Republican-led states that initially said no have gotten permission to craft their own version of coverage.  Indiana was the most recent in late January,   and N.C. Gov. Pat McCrory has signaled some interest in crafting a North Carolina plan.

"As we review continue to review health care options for the uninsured,  we are exploring North Carolina-based options that will help those who can't help themselves, and encourage those who can,"  McCrory said in Wednesday's State of the State address.  "If we bring a proposal to cover the uninsured, it will protect North Carolina taxpayers. And any plan will require personal and financial responsibility from those who would be covered."



Read more here: http://www.charlotteobserver.com/2015/02/04/5494786/text-of-nc-gov-mccrorys-state.html#storylink=cpy
As the pro-expansion advocates noted,  that's still far from a specific plan.  And there's still little sign that Senate President Pro Tem Phil Berger or newly elected House Speaker Tim Moore are on board for any kind of expanded coverage.

Thứ Năm, 5 tháng 2, 2015

Separated, uninsured and out of luck?

A reader who's in the process of divorce emailed to ask whether there's any way he can get help paying for health insurance this year.

He works part time and says he'd spend half his take-home pay buying a private policy.  His wife makes a lot more,  and the reader says he was told that because they're not divorced,  his household income includes her pay,  which puts him out of range for tax credits on the Affordable Care Act exchange.
Image: wikihow.com
"I was just wondering if I’m screwed until I am officially divorced,"  he said.

I thought I knew the answer  (yes,  but you can apply once the divorce goes through),  but Madison Hardee of Legal Services of Southern Piedmont says it's not that simple.

"Marketplace eligibility for couples who are married but separated is complicated,"  she wrote.  "You are correct that the marketplace asks consumers for their current marital status. However,  at tax filing,  the IRS will consider the marital status on December 31st of the tax year.  For example,  if a consumer is currently married and then gets divorced in July 2015,  the IRS will consider that person unmarried for the entire 2015 tax year."

So if the reader,  who asked that I not share his name,  applies now,  he'll presumably be denied any financial aid based on the combined income.  And if he doesn't enroll in a plan before the Feb. 15 deadline,  he won't automatically be eligible for special enrollment based on the divorce.  But if he enrolls now,  he can go back to HealthCare.gov after the divorce,  report the change in income and select a new plan if he qualifies for subsidies,  Hardee said.

Hardee is a lawyer who has been trained in ACA enrollment,  so she added even more caveats based on special circumstances.

My takeaway:  Anyone like this reader,  who faces crucial decisions about paying for care,  needs to hustle to take advantage of 10 more days of free assistance.  Don't ask your neighbor or your aunt or even a reasonably well-informed reporter.  Sit down with an expert who can review your individual circumstances and talk you through options.

To get free help in North Carolina, call 855-733-3711 or visit www.getcoveredamerica.org/connector. In South Carolina, call 888-998-4646 or visit www.signupsc.com.  Don't dawdle;  I'm hearing that appointments are filling up.

You can also call an insurance broker.  Or do a walk-in at Get Covered Mecklenburg's last-minute enrollment event from 10 a.m. to 4 p.m. Feb. 14 at the Children and Family Services Center, 601 E. Fourth St.

Just don't kick yourself on Feb. 16 for procrastinating.

Read more here: http://www.charlotteobserver.com/2015/01/23/5466303/obamacare-enrollment-grows-in.html#.VNKaf2jF_GE#storylink=cpy




Thứ Tư, 4 tháng 2, 2015

Can GOP reform Obamacare?

As the Republican-led Congress begins its 2015  "repeal the Affordable Care Act"  season,  this seems like a good time to loop back to Philip Klein's examination of GOP alternatives for health care.

Tuesday's vote on H.R. 596 is part of an ongoing political drama that has already featured more than 50 house votes to repeal the ACA.  But in "Overcoming Obamacare,"  conservative health writer Klein delves into three long-term conservative strategies to reshape a broken system.

Roy
Avik Roy of the Manhattan Institute,  a former adviser to the Mitt Romney presidential campaign,  is a leading voice in what Klein dubs the reform camp.  Roy's plan preserves some elements of the ACA,  including the insurance exchange and protections for people with pre-existing conditions.

"Roy's philosophical starting point on the health care issue differs from that of many conservatives in that he has argued in favor of universal coverage, calling it  'a morally worthy goal.'  His plan is also based on the assumption that repeal is unlikely,"  Klein writes.

Roy's reform plan outlines changes that can be made piece by piece,  such as eliminating many of the ACA taxes,  allowing insurers to charge higher rates for older customers and extending private-insurance exchanges to Medicaid and Medicare.  He touts it as a politically feasible strategy that would make insurance cheaper and more appealing for young people while costing taxpayers less than the ACA.

Klein predicts that it's more likely to alienate members of both parties,  with Democrats resisting the changes while Republicans  "would be expected to embrace the goal of universal coverage" and  "cede major ground to Obamacare on taxes,  spending and regulations."

Coming soon:  A look at the "replace"  and  "restart"  strategies.