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Obamacare/Affordable Care Act open enrollment starts today and ends December 15: Move fast

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I just received an email from Vox:

Obamacare’s sign-up period starts today.

The 9 million Americans who purchase coverage through the health law’s marketplaces have from now until December 15 to pick their 2018 coverage. For those buying coverage — or just interested observers — here are the five things you need to know about this open enrollment period.

1) Open enrollment is short this year — 45 days instead of 90. Over the past few years, the Obamacare open enrollment period typically ran from November 1 through January 31. That gave enrollees about three months to pick a plan. Many would wait up until that late January deadline to sign up. That will not work this year. The enrollment period now ends on December 15, which means that shoppers will have to move quicker to sign up for coverage this time around.

2) Premiums for some Obamacare plans are spiking by double digits. The cost of mid-level silver plans is rising a lot this year, on average 37 percent, according to Health and Human Services estimates. Most of that rate hike is due to the Trump administration’s decision not to pay cost-sharing reduction subsidies. I wrote more about this in yesterday’s VoxCare, but essentially insurers jacked up premiums to offset the loss of this other funding source. This means that the sticker price of silver plans often looks a lot higher this year. But…

3) There are some great deals to be had on bronze and gold plans. In many states, health plans made their biggest premium increases in their silver plans. This is important because (again, this builds on yesterday’s newsletter) the size of the premium tax credit is tethered to the price of the silver plans. More expensive silver plans mean bigger premium tax credits. And Obamacare enrollees can take those credits to buy a less generous plan (called a bronze plan) for a really cheap price, maybe even free.

Many Maine residents, for example, qualify to buy these bronze plans with a zero-dollar premium, the Portland Press-Herald reports.

Shoppers can also go in the opposite direction: use their new big tax credit to buy a more generous gold plan at a lower out-of-pocket price.

4) It is really, really, really important to shop for coverage this year! The prices for Obamacare insurance this year are, well, just weird. Sometimes plans with low deductibles cost more than plans high deductibles. There are a decent number of free health insurance plans out there for people who receive financial assistance paying their premiums. And there are some really expensive plans out there, too.

All of this makes it so important for Obamacare enrollees to shop for coverage. There are a lot of cases out across the country where enrollees could save hundreds or thousands of dollars by switching health insurance. There is the opportunity, in many cases, for enrollees to get a better plan for a cheaper price. This year more than ever, it is crucial that enrollees compare their options.

If you need a bit of help, the New York Times has put together a great guide to how different Obamacare enrollees in different situations can best shop for coverage. Check it out here.

5) There is enrollment help out there — just less of it. The Trump administration made steep cuts to Obamacare outreach. Funding for in-person assistance fell 72 percent this year, and some groups closed up shop entirely.

Still, there is help out there. Get America Covered offers a tool that lets Obamacare enrollees search by zip code to see the closest Obamacare navigators and even make online appointments.

Those groups are scrambling to provide assistance in this shorter enrollment period, so it’s better to get an appointment early rather than wait till the last minute.

Are you an Obamacare enrollee who has questions about this year’s sign-up period? Covered Florida will be dropping into our Facebook group to help provide guidance. If you’re an Obamacare enrollee, you can join the group here.

Written by LeisureGuy

1 November 2017 at 12:27 pm

Glasses Are Cool. Why Aren’t Hearing Aids?

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Full disclosure: I use hearing aids. A few years ago, The Eldest (who works in public health) pointed out an article to me on the effects of hearing loss. As this study found, “Hearing loss is independently associated with accelerated cognitive decline and incident cognitive impairment in community-dwelling older adults.” That certainly got my attention. I immediately had a hearing test and bought the hearing aids prescribed, which I continue to use. And I also wear glasses.

Jennifer Finney Boylan writes in the NY Times:

If I do my job right, this column might actually change your life. More important, it might change the lives of the people you love.

But first, I need to talk about Elton John’s glasses. It was my first concert. Philadelphia Spectrum, 1972. Elton opened up with “Tiny Dancer” on solo piano. Later, during “I Think I’m Going to Kill Myself,” a character named Legs Larry Smith came out and tap danced.

But none of that is what I remember best. What has stayed with me all these years has been those stylish glasses. Spotlights flooding the stage twinkled off his rims.

Back then, I wore glasses, too. Until that moment, I had never thought of them as a fashion statement. I just thought of them as a way of existing in the world.

But of course glasses were, and are, a fashion statement. Eyewear practically defines certain people’s style. Teddy Roosevelt and his pince-nez. Iris Apfel and her signature circular specs. Mr. Peanut, rocking a monocle. In my 20s I knew a girl with perfect eyesight who even had a pair of clear glasses designed for her. “So that I look hot,” she explained, “when I take them off.”

Why, I wonder, is it that devices to keep you from being blind are celebrated as fashion, but devices to keep you from being deaf are embarrassing and uncool? Why is it that the biggest compliment someone can give you about your hearing aids is “I can hardly see them”?

Hearing loss is endemic, and not just for older people. Almost one in four Americans between the ages of 20 and 69 who think they have good hearing actually have some hearing impairment. Among those in their 50s, 4.5 million people have some hearing loss. How many wear devices that would enable them to better hear the world? Less than 5 percent.

Wearing hearing aids can change your life in an instant — not to mention that of the people you love, whose actual voices you may have been unable to hear. But we don’t get help. Because coverage by insurance carriers is inconsistent. Because we don’t know where or how to get our hearing tested. Because we’re afraid of what others might think. Because hearing loss is uncool.

This needs to change. Start with insurance: Hearing aids can be expensive, but employers need to know that people who can’t hear can’t do their jobs well. Education matters, too: People who thought it was dumb for Donald Trump to look directly at the sunduring the solar eclipse might think nothing of slapping on a pair of headphones and cranking their music to 11.

The first thing you can do is to get your hearing tested; this is helpful even if you don’t think you have hearing loss, so that you have a baseline reference. There are several free tests online, sponsored by PhonakMiracle-Ear, Beltone and others. They aren’t as good as the ones a doctor can give you, but it’s a start.

About 90 percent of hearing loss is “sensorineural,” usually caused by damage to hair cells in the inner ear. Sometimes it’s the result of exposure to loud sounds (like concerts at the Spectrum). That’s the kind of hearing loss I have; my inability to hear high-pitched sounds means that understanding a conversation in a crowded restaurant can be a challenge.

New technology enables wearers to focus their hearing on the person in front of them while canceling out all sound behind. You can control just how much of the world you want to amplify or cancel out by using a free app on your mobile device. And it looks good — I recently wore such a device at a party where, for the first time in years, I heard everything that everyone was saying. It completely changed the way I experienced the world.

When I first learned that I had serious hearing loss (after a lifetime of playing in super-loud bands), I called my wife on the phone, and as I told her of my diagnosis I started to cry. “I’m so sorry you have to be married to someone like me,” I sobbed. . .

Continue reading.

Written by LeisureGuy

1 November 2017 at 12:05 pm

What’s killing America’s new mothers?

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Annalisa Merelli writes in Quartz:

Elizabeth “Liz” Logelin was a young, fit woman with a promising career in operations management at Disney. On March 24, 2008, after a complicated pregnancy that saw her bedridden for nearly two months (three weeks of which were in the hospital), she delivered her daughter Madeline (Maddie) through an emergency cesarean section. Two and a half months early, Maddie was healthy, if tiny. Twenty seven hours after the delivery, Liz was finally cleared to hold her firstborn. Her husband Matt Logelin already was, he teased her, several diaper changes ahead of her. She got up from the bed, ready to make her way to the nursery, and stopped in front of the mirror. “My hair looks like shit,” she said, of her long tresses. She laughed, Matt laughed, the nurses laughed. He thought her hair looked great.

She walked towards the wheelchair that was going to take her to the nursery, and suddenly didn’t feel well. “I feel lightheaded,” she complained. Moments later, at age 30, Liz was dead.

The cause was a pulmonary embolism—a blood clot that travelled from her leg to her lungs, and killed her instantaneously.

Though she had a family history of blood clots, suggesting a genetic predisposition, and her risk was increased by the prolonged bed rest and the subsequent c-section surgery, to Matt’s knowledge Liz wasn’t given anticoagulant medications, or advised to exercise to help stimulate her blood flow. Everyone’s attention, hers included, was turned elsewhere, to baby Maddie—so precious, so perfect.

There’s an assumption that death from childbirth is just not something that happens—not in America, or at the very least not in Matt and Liz’s America. “We were very healthy people living in Southern California, with great jobs; [Liz] was very healthy—she didn’t smoke, she barely drank,” Matt says. “We thought we were untouchable,” he adds ruefully.

But dying of childbirth, Matt would learn in the worst possible way, did happen in America. Even to women as young and healthy as Liz, with access to good medical care, and the wherewithal to understand and follow up on their doctor’s advice.

On that May day, she joined one of the US’s most shameful statistics. With an estimated 26.4 deaths for every 100,000 live births in 2015, America has the highest maternal mortality rate of all industrialized countries—by several times over. In Canada, the rate is 7.3; in Western Europe, the average is 7.2, with many countries including Italy, Norway, Sweden, and Austria showing rates around 4. More women die of childbirth-related causes in the US than they do in Iran (20.8), Lebanon (15.3), Turkey (15.8), Puerto Rico (15.1), China (17.7), and many more.

While most of the world has drastically reduced maternal mortality in the past three decades, the US is one of just a handful of countrieswhere the problem worsened, and significantly.

Between 700 and 1,200 women die from complications related to pregnancy or childbirth every year in the US. Fifty times that number—about 50,000 in all—narrowly escape death, while another 100,000 women a year fall gravely ill during or following a pregnancy.

The dire state of US data collection on maternal health and mortality is also distressing. Until the early 1990s, death certificates did not note if a woman was pregnant or had recently given birth when she died. It took until 2017 for all US states to add that check box to their death certificates. Calculating the number of near-deaths and severe illnesses related to pregnancy is still guesswork. There is no standard or official method of tracking, and cases are not routinely documented. In other words, data collection about maternal health and mortality is a complete mess. Even gathering reliable data for this story was difficult. Quartz was forced to turn to state data where there was a lack of national data, and to supplement gaps of any data with anecdotal evidence. If the US does not know it faces a crisis, how can it reverse the tide, and prevent the needless death of the next Liz Logelin?

Quartz probes the sorry state of US maternal data in a separate story.

The lack of proper documentation of maternal health is about more than data collection though, and speaks volumes about what little thought or consideration has been given to expectant and new mothers in the US. It’s hard to avoid the inference that they’re not considered important enough to merit focused attention. It’s certainly representative of a bigger problem, that women in the US are not getting the medical attention they need. It’s as though the US is rendering its mothers invisible.

“It’s the biggest catastrophe that we have in medicine to have young mothers die of preventable causes,” says Elliot Main, the medical director of the California Maternal Quality Care Collaborative (CMQCC).

Determining exactly why so many American mothers are dying of, or suffering through, pregnancy is a gargantuan public-health puzzle. Through the course of reporting this story, it quickly became apparent that there is no single reason, but instead a complex brew of factors that, together, point to deep-rooted, systemic problems that run through the entire social and health care system of the country. Gender, class, race—and across all, a fragmented, mainly private health system—conspire to work against maternal health. In many ways, it’s a litmus test of the health of health care in the US. . .

Continue reading. There’s more.

Written by LeisureGuy

30 October 2017 at 4:22 pm

Trump’s opioids declaration was missing one key thing: money

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Ella Nilsen reports in Vox:

President Donald Trump declared America’s opioid crisis a public health emergency on Thursday, after sending mixed signals on the issue for the past three months. But there’s one big thing missing: money.

Trump won’t direct any new federal money to the opioid crisis, per administration officials. The declaration will free up the federal Public Health Emergency Fund to be used to fight the drug epidemic, but Congress hasn’t replenished the fund in years. There’s just $57,000 left in it — and public health experts say that a serious response to the addiction crisis would cost $183 billion over the next decade.

For public health officials, doctors and treatment advocates on the ground in states hardest hit by the epidemic, the federal government – under both the Obama and Trump administrations – has been slow to respond to America’s deadliest drug crisis, which killed a record 64,000 Americans last year.

Trump’s Thursday declaration, though encouraging, wasn’t the decisive action that many were looking for.

“I think it was a step forward but it wasn’t the big step, because it does not bring new money,” said Tym Rourke, chairman of the New Hampshire Governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment, and Recovery and a longtime treatment advocate in the state. New Hampshire has the second highest rate of fatal drug overdoses in the nation, behind West Virginia.

“There are unmet needs right now that this declaration, while welcome, does not address,” Rourke said. “If we don’t get additional resources on the ground, there is only so much positive impact we can have.”

In West Virginia, where the death toll from heroin, fentanyl and prescription opioids is the worst in the United States, public health officials say they want help from the federal government matching the scale of the devastation they see every day.

“People are dying out here,” said Michael Brumage, executive director of the Kanawha Charleston Health Department in Charleston, West Virginia, in a recent interview. “We are having a Vietnam in America every single year from overdoses. If this is a war, why would we not apply the resources as we could?”

Brumage said he believes there’s a disconnect between government officials in Washington D.C. and people who are seeing the toll of the drug crisis play out every day in America’s communities.

“When you’re sitting in a position of power and you’re removed from the day to day misery of this epidemic, I believe it’s easy to dismiss,” Brumage said. “I think at an intellectual level they see the numbers of deaths from overdoses, but they’re abstractions because they’re figures on a piece of paper.”

“The public health hurricane of our generation”

Hard-hit states like New Hampshire and West Virginia have already had mixed experiences with the government’s response to the opioid crisis: they’ve gotten much less help than states with lower death rates.

The 21st Century Cures Act, passed last year, included $1 billion to be dispersed among states for drug treatment. The bill’s intent was for more federal money to go to states with the highest per capita drug death rates.

But after the bill was signed into law by President Obama, the Substance Abuse and Mental Health Services Administration changed the funding formula to take into account states with the biggest overall numbers of overdose deaths.

That meant more populous states like California, Florida and Texas got the most money, even though their per capita death rates were much lower. New Hampshire, with the second-highest death rate in the nation, received about $6.2 million over two years. Texas, with the fourth-lowest per capita rate for drug fatalities in the US, received $27.4 million. . .

Continue reading.

Written by LeisureGuy

28 October 2017 at 12:19 pm

Republicans propose $1.5 trillion deficit increase for tax cuts, but won’t pay for children’s healthcare program

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I suppose Republicans are okay with increasing the deficit by $1.5 trillion if it means the wealthy will get big tax cuts, but to increase the deficit to help the public: no dice. Read Kevin Drum’s post, which concludes:

. . . This is a good time to remind everyone that Republicans just passed a budget that contained instructions for a net $1.5 trillion tax cut that will mostly benefit corporations and the rich. But $8 billion in net spending increases to provide medical care for kids? Sorry. Can’t be done. Gotta watch the deficit, you understand.

Or maybe they could fund CHIP and settle for a $1.492 trillion tax cut? That’s out of the question, of course.

At times like this I wish I were a religious man. At least then I’d feel some sense that eventually these meanspirited bastards would pay for their sins.

Written by LeisureGuy

26 October 2017 at 5:55 pm

How Many American Women Die From Causes Related to Pregnancy or Childbirth? No One Knows.

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It’s difficult to escape the conclusion that the US government is not doing its job. Robin Fields and Joe Sexton report in ProPublica:

The questions are straightforward, with public health implications that would seem impossible to shrug off.

How many American women die each year from causes related to pregnancy or childbirth? How many of these deaths are preventable? How does the nation’s current rate of maternal mortality compare to the rate 10 or 20 or 30 years ago?

The answers are central to any true picture of U.S. maternal health, and an essential tool in limiting such tragedies going forward. Much as an accurate census is vital to a functioning democracy, so reliable information on what goes right or wrong in pregnancy and childbirth is key to saving lives.

Yet because of flaws in the way the U.S. identifies and investigates maternal deaths — a process perennially short on funding and scientific attention — what data exists on this particular set of vital statistics is incomplete and untrustworthy. Indeed, for the last decade, the U.S. hasn’t had an official annual count of pregnancy-related fatalities, or an official maternal mortality rate — a damning reflection of health officials’ lack of confidence in the available numbers.

“Our maternal data is embarrassing,” said Stacie Geller, a professor of obstetrics and gynecology at the University of Illinois College of Medicine and a leading scholar on the subject. “Maternal health in the U.S. is simply still not a priority. It’s not interesting.“Preventable maternal deaths are not in the basement of our priorities, they are in the sub-basement.”

It’s generally agreed upon that about 700 to 900 American women die each year for reasons tied to pregnancy and that many of these deaths are preventable. Over the last two decades, other affluent nations have reduced their maternal mortality rates, in some cases dramatically.

The best estimates show U.S. rates rising over that period, but those estimates vary — a lot. A study in The Lancet put the 2015 U.S. rate at . . .

Continue reading.

One cannot help but wonder whether this receives so little attention and funding because it affects women only.

Written by LeisureGuy

23 October 2017 at 2:28 pm

Trump is at risk of blowing it on opioids, a member of his own commission warns

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Greg Sargent writes in the Washington Post:

As early as this week, President Trump is set to declare the opioid crisis a “national emergency.” Trump telegraphed this when he recently told reporters that he would soon have a “major announcement” on the “massive opioid problem,” and people inside the White House are now leaking word that this announcement will herald an all-hands-on-deck push to combat the epidemic.

But members of Trump’s own handpicked commission to combat the epidemic aren’t nearly as confident, I’m told. They are increasingly worried that the Trump administration will not actually follow through with a robust response, even if he does go before the cameras and declare the crisis a national emergency, and they are increasingly annoyed by the efforts of people inside the administration who are resistant to such a response, one member of the commission says.

In a surprisingly blunt interview with me, Patrick Kennedy, the former congressman from Rhode Island who is a member of the President’s Commission on Combating Drug Addiction and the Opioid Crisis, candidly described the mood on the commission as one racked by pessimism about the president’s willingness and ability to follow through with a response that matches the scale of the human disaster that has unfolded.

The commission is set to release a final report of recommendations for combating the crisis on Nov. 1, and “the worry is that it won’t be adopted,” Kennedy tells me.

This apparently includes the head of Trump’s commission: New Jersey Gov. Chris Christie (R), whom Trump picked for the role. Kennedy told me that Christie has confided to him that he thinks failure on the opioid crisis could deal a debilitating blow to Trump’s presidency.

“Christie doesn’t mince words,” Kennedy said. “He said, ‘If he doesn’t recognize this as the issue of our time, his presidency is over.’ ” Kennedy added that Christie, an early supporter of the president, said he had conveyed a variety of this sentiment to Trump himself.

In August, the commission — which was created by Trump via executive order in March — released a preliminary report urging the president to declare the opioid crisis a “national emergency,” arguing that this would “empower your cabinet to take bold steps and would force Congress to focus on funding” a serious response to the epidemic. Such a declaration could also give the executive branch more flexibility to direct appropriated funds toward combating the crisis.

Since then, it has been unclear whether Trump would actually go through with the declaration — that is, until last week, when he suddenly vowed that he would be doing just that. Politico reported that this blindsided members of the Trump administration, who are scrambling to figure out how a response commensurate with that declaration would be implemented. Politico also quoted unnamed officials saying that some in the administration, such as budget chief Mick Mulvaney, are wary that a declaration of national emergency could lock the administration into supporting overly large public expenditures to combat it.

Kennedy confirmed this to me on the record and went even further, claiming that these differences had resulted in tensions between Christie and administration officials such as Mulvaney. “The tension is between the Mulvaney crowd, who is ideological about the numbers, and the Christie crowd, whose fidelity is towards the reality of what’s most practical,” Kennedy said, adding that there are “internal arguments” underway that he defined this way: “Can we do this on the cheap, or are we going to be serious about saving lives?”

The basic argument

The key distinction to understand here is this: While it is certainly desirable for Trump to declare a national emergency, it is not clear how meaningful that will prove in substantive terms, even if he does it. Axios reports that the administration is preparing a massive “public relations” effort that will include unspecified requests for funds and a public role for Melania Trump.

But, while such a general vow of seriousness will be welcome, what matters is the follow through. “Visiting rehab centers … been there, done that,” Kennedy said, by way of illustrating the difference between photo ops and an actual response.

This is where the recommendations of the president’s commission come in. Kennedy tells me that the commission members are converging on a fairly robust set of recommendations that include expanded health insurance coverage, training and deploying health-care workers to fill the requests of states for help, and additional subsidies to fund addiction treatment.

It will be on the administration to determine how to implement such a set of responses and what it might cost, but Kennedy says commission members worry that the administration will try to lowball that cost. “To implement the recommendations that we’ll offer, it will require hundreds of billions of dollars,” Kennedy says.

Vox recently published a good rundown on what experts think will be needed to combat the crisis. A combination of tactics is called for, including . . .

Continue reading.

Written by LeisureGuy

23 October 2017 at 9:53 am

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