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Daily Archives: December 10, 2013

Acid-suppressing medications associated with vitamin B12 deficiency

Use for 2 or more years of proton pump inhibitors and histamine 2 receptor antagonists (two types of acid-inhibiting medications) was associated with a subsequent new diagnosis of vitamin B 12 deficiency, according to a study appearing in the December 11 issue of JAMA. “Vitamin B 12 deficiency is relatively common, especially among older adults; it has potentially serious medical complications if undiagnosed.

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Use of CPAP for sleep apnea reduces blood pressure for patients with difficult to treat hypertension

Among patients with obstructive sleep apnea and hypertension that requires 3 or more medications to control, continuous positive airway pressure (CPAP) treatment for 12 weeks resulted in a decrease in 24-hour average and diastolic blood pressure and an improvement in the nocturnal blood pressure pattern, compared to patients who did not receive CPAP, according to a study appearing in the December 11 issue of JAMA. “Systemic hypertension is one of the most treatable cardiovascular risk factors.

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Obamacare Benefits Elusive For Many Working Poor In Northern Florida

Getting people to sign up for health insurance under Obamacare is an uphill battle in much of Florida. Politicians have put up roadblocks to the law from the beginning – from joining in the lawsuit to thwart it in 2011 to placing restrictions on what health care navigators can discuss with those they advise.

That means many don’t know what the law might offer them.

Obamacare is not very popular at the World’s Largest Free Fish Fry in Perry, Fla. (Photo by Eric Whitney).

So in the state that has the second highest rate of uninsured residents in the U.S., advocates are trying get the word out that an estimated 1.6 million Floridians qualify for new subsidies to make coverage more affordable.

Not everyone wants to listen. The message will be hardest to get across, many say, in Florida’s panhandle, where sandy white beaches on the Gulf Coast back up to vast pine forests. Towns are small and scattered. The area is closer both politically and geographically to neighboring Georgia and Alabama than faraway Miami.

At local events like the recent Florida Forestry Festival and “World’s Largest Free Fish Fry” in Perry, it’s not hard to find people like Elijah Mott, an itinerant heavy equipment operator who says he doesn’t know much about the health care law and that most of what he’s heard is bad.

“I think it sucks,” he says.

The median household income in this county is about $40,000 a year. Lots of jobs here don’t come with health insurance. That means many here, like Mott, who doesn’t have steady work or insurance at the moment, probably qualify for subsidies to help them afford coverage.

But Mott isn’t buying that the health law could possibly be good for his family.

“I would have to say no,” Mott says, “I haven’t investigated deep enough to know if there is anything.”

Mott, and 41-year-old Michael Dees of Mayo, who works in a paper mill, have mostly heard that Obamacare is going to increase the price of health insurance, making it more unaffordable for people like him.

Dees says he expects to be laid off soon and worries about how he’s going to buy coverage for his family.

“Who can afford $700 a month?” he asks. “It’s easier to pay for the damn penalty at the end of the year the IRS is going to charge you than pay $500 a month.”

Dees says it’s news to him that the health law offers people making less than $45,960 a year help paying monthly premiums.

“I really hadn’t heard about the subsidy,” he says.

Guys like Dees and Mott are exactly who health law advocates like Karen Woodall are trying to reach. A longtime lobbyist for children’s and family issues in Florida’s capital of Tallahassee, she says it’s tough to convince people here that the law might help them.

“It’s challenging to overcome messages that are coming out of elected officials’ offices and a governor’s office,” she says.

Florida said no to both the law’s Medicaid expansion, and to tens of millions of dollars to advertise new subsidies for those with incomes between 100 and 400 percent of the federal poverty level

Privately-funded groups like Enroll America are trying to supply the outreach and education in Florida. That includes partnering with churches like the Sanctuary at Mt. Calvary in urban Jacksonville, on Florida’s Atlantic coast about three hours east of Perry.

Pastor John Allen Newman invited Enroll America representatives to address his congregation one recent Sunday. From the pulpit, he warns his flock of several hundred against misinformation he says opponents of the law are spreading.

“People perish for what?” he asks from the pulpit.

“Lack of knowledge,” comes the practiced response.

Newman tells congregants that the law helped him get coverage after a large, private insurer turned him down because of a preexisting condition.

“This Affordable Care Act is saving lives.”

The message hits home with 23-year-old truck driver Anthony Person. “I never knew what it was before until I started coming to this church.” Person says. Pastor Newman, he says, “started explaining it to us the way I could understand it.”

Person left his contact information at the Enroll America table in the church’s lobby, to get help signing up for new Obamacare coverage. “My job is one that does not have the best benefits, so I need health insurance to cover myself,” he says.

And then, there are those who might just fall through the cracks.

Back in the Panhandle, resident Karen Ray wishes subsidies to help working people afford coverage had been available when she was running her small business out of Del Ray Beach.

“There hasn’t been a realization how many people out there are the working poor,” she says, “working hard and not getting health care. And just living paycheck to paycheck and hoping nothing goes wrong.”

Things went wrong for Ray in a big way after the BP oil spill in 2010. “I had a beach wedding business, and it kind of went downhill after the oil spill,” she says. “I’ve just been trying to get back on my feet since then.”

Even before the oil spill her business never generated enough income to provide health insurance the 60-year-old Ray says. She used to get coverage through her husband’s job.

“I lost my business, and my marriage, and my house, at the same time,” she says, laughing wryly.

That’s left her uninsured. She knows about the law – and she also knows, that because she lives in Florida, she is unlikely to benefit from it.

If Ray lived in one of the 25 states expanding Medicaid, she would qualify for new coverage. But because Florida isn’t expanding, being poor alone isn’t enough to get Medicaid here. Benefits here are reserved primarily for children, pregnant women and the disabled.

And because Ray has no income, she won’t qualify for new Affordable Care Act tax credits designed to help the working poor afford private health coverage.

“I could maybe scrounge up the money to go get a mammogram,” Ray says, but, “what if it comes back positive? What happens to me? It’s not like you can show up in the emergency and say, ‘Ooh! I have an emergency lump!’ That won’t happen.”

“I think a lot of us are going to fall through the cracks,” Rays says, “and I’m very irate about that, very irate about that.”

This story is part of a partnership that includes NPR and Kaiser Health News, with the support from the Dennis A. Hunt Fund for Health Journalism, a program of the USC Annenberg School of Journalism’s California Endowment Health Journalism Fellowships. 

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Low folate in male diet linked to risk of offspring birth defects

Previous research has shown that what mothers eat during pregnancy affects the health of their offspring. But now, a new study suggests that a father’s diet prior to conception could also play an important role in their child’s health, particularly when it comes to consumption of folate.Folate, also known as vitamin B9, is found naturally in a broad variety of foods, including dark green leafy vegetables, nuts, beans, peas, fruit and fruit juices, dairy products, poultry and meat, eggs, seafood and grains.

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Type 2 diabetics 'have better glucose control' with exercise game

Exercise video games are used by many people worldwide to adopt a regular exercise routine, help with weight loss or to simply play with friends. But new research suggests the popular games could help people with type 2 diabetes to improve control of their glucose levels.Type 2 diabetes occurs when cells in the body that produce insulin are unable to make enough, or when the insulin that is produced does not work effectively – known as insulin resistance.

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Five healthy behaviors lower dementia risk, study shows

A 35-year study from the UK cites five lifestyle behaviors that have been shown to reduce the risk of cognitive decline, and researchers say these healthy habits are more beneficial than medical treatments or preventative procedures.The study, published in the journal PLOS One, was led by Prof. Peter Elwood of Cardiff University’s School of Medicine.He and his team analyzed data from the Caerphilly Cohort Study, which recorded healthy behaviors in 2,235 men aged 45-49 from 1979 to 2004, in Caerphilly, UK.

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Senate Finance Committee Scheduled To Vote Thursday On 'Doc Fix' Legislation

The measure would permanently change how Medicare pays providers for their services. In addition, the Congressional Budget Office has reduced the price tag associated with repealing the current Medicare payment formula.

The Wall Street Journal: Permanent Fix For Medicare Fees Seen
An annual push by doctors to delay cuts to Medicare patient fees is afoot, but this time the prognosis is better for a permanent solution to the long-festering problem. The Senate Finance Committee is scheduled to vote Thursday on “doc fix” legislation that would permanently change how Medicare providers are paid by the government for their services. Similar legislation was unanimously passed by the House Energy and Commerce Committee in July (Schatz, 12/9).

Medpage Today: CBO Cuts Cost Of SGR Repeal Yet Again
The Congressional Budget Office (CBO) has again lowered the price tag for repealing Medicare’s much-derided sustainable growth rate (SGR) physician payment formula, dropping it by nearly $23 billion. The 10-year cost estimate for doing away with the SGR is now $116.5 billion, the CBO said late Friday. The previous estimate, made this past February, was $139 billion, which was much less than the $271 billion price tag that CBO had given the idea in August 2012. Lawmakers said the lower price tag could make it easier it finally repeal the SGR, which has been a major focus of Congress this year (Pittman, 12/9).

Meanwhile, in the background —

Politico: Why The Timing Is Right For A Budget Deal
John Boehner and Barack Obama failed. Harry Reid, Boehner and Mitch McConnell didn’t fare much better. Eric Cantor and Joe Biden barely got started. But with the year winding to a close, Sen. Patty Murray (D-Wash.) and Rep. Paul Ryan (R-Wis.) are nearing a modest, yet important, budget deal that senior aides say could be rolled out as soon as Tuesday and voted on later this week (Sherman and Bresnahan, 12/10).

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Tax Employer Health Care Plans? GOP Rethinks Proposal, Continues Health Law Barrage

A GOP proposal to begin taxing employer-based health care benefits is worrying some Republicans that such a move could hurt the party politically ahead of 2014’s elections. In the meantime, Republicans are continuing their attack on Democrats over the health law using phrases like “broken promise” and “extraordinary disruption” to describe the law.

The Wall Street Journal: Republicans Shy Away From Their Own Health Plan
Democrats’ politically bruising experience over the Obama health law has prompted leading Republican policy experts to rethink one of the party’s own long-standing ideas about remaking the health care system. President Barack Obama and his party have suffered in public-opinion polls amid the health site’s troubled rollout and as some five million people lost existing coverage that didn’t meet new standards, even as the law seeks to expand coverage to many more Americans. Some Republicans are now worried that a GOP proposal to begin taxing health care benefits offered through employers — which would affect some 160 million Americans — would cause market disruptions far more severe and expose the party to its own political peril (Meckler, 12/9).

Politico: GOP Ads Tie Dems To ACA ‘Broken Promise’
Republicans are using House Democrats’ own words against them in a new set of radio ads that tie the lawmakers to the bungled Obamacare rollout. Specifically, the National Republican Congressional Committee’s ads, which launch Tuesday, focus on President Barack Obama’s “broken promise” that people could keep their old insurance plans under the new health law. Republicans spent weeks digging through old clips and statements from Democrats in hopes of catching them making the same pledge (Isenstadt, 12/Ǫ). 

The Washington Post’s The Fact Checker: McConnell’s Claim Of Obamacare ‘Extraordinary Disruption’ For Americans With Health Insurance
Sen. McConnell, the Republican leader, has long been a critic of the Affordable Care Act, a.k.a. Obamacare. But his recent comments on Fox News appeared overheated: Are the 85 percent of Americans who have health insurance facing “extraordinary disruption”? McConnell’s comments in some ways are the flip side of President Obama’s claim earlier this year that “the 85 and 90 percent who already have health insurance” will not notice anything but better health care. He argued that impact will be felt instead by “that small group of people — 10 to 15 percent of Americans now, it’s still 30 million Americans, but relatively a narrow group — who don’t have health insurance right now or are on the individual market and are paying exorbitant amounts for coverage that isn’t that great” (Kessler, 12/10).

And Republican Sen. Lindsey Graham has enrolled in coverage under the law, but declined to take a federal subsidy —

The Washington Post: Lindsey Graham Enrolls Under Obamacare, Declines Federal Subsidy
Sen. Lindsey Graham (R-S.C.) became the latest U.S. lawmaker to enroll in a federal health insurance exchange but forego the federal subsidy he would normally receive for his premium. Graham announced Monday he would enroll in his home state’s exchange, which is being run by the federal government, even though he opposes the Affordable Care Act. The congressional open enrollment period ends Monday. Senators are allowed to receive a federal subsidy covering roughlyೋ percent of their health care premiums under the law by enrolling in the D.C. Health Link exchange. But at least 12 senators have waived their employer contribution and joined either a state-run exchange or the federal exchange (Eilperin, 12/9). 

Politico: Lindsey Graham Declines Health Care Contribution
Graham, who is 58 and single,said he will pay $400 more per month under Obamacare than under his current plan. But that significant increase is also likely due to the fact that he is turning down his employer contribution — which can cover as much asೋ percent of the costs of health care plans (Kim,12ǟ).

CNN: GOP Sen. Graham Latest To Sign Up For Obamacare, Refuse Subsidy
Republican Sen. Lindsey Graham has decided to sign up for federal health care coverage in the South Carolina exchange, rather than through the Washington, D.C., exchange where he would qualify for a federal subsidy offered to both lawmakers and congressional aides. “I don’t think members of Congress should get a special deal,” Graham said in a press release. “Obamacare is being pushed on the American people and we should live under it just like everyone else,” he added (Sommers, 12/9).

ABC News: Colin Powell Pitches Single-Payer Health Care In US
Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea. “I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life,” Powell said, according to the Puget Sound Business Journal, last week at an annual “survivors celebration breakfast” in Seattle for those who, like Powell, have battled prostate cancer (Lazar, 12/9).

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Oregon Gov. Kitzhaber To Seek 4th Term; Health Care Will Likely Be A Campaign Issue

John Kitzhaber announced he intends to seek an unprecedented fourth term. In the background, his state continues to experience difficulties with Cover Oregon, the state’s online insurance marketplace.   

Los Angeles Times: Oregon Governor Opens Bid For 4th Term Despite Rocky Obamacare Rollout
When Oregon Gov. John Kitzhaber announced his bid for a fourth term Monday, it was no surprise that he did so at an elementary school – a long way from the headquarters of Cover Oregon where software engineers are still trying to fix problems with the state’s healthcare exchange and get it online (Reston, Ǭ/9).

The Washington Post: Oregon’s Kitzhaber Will Run For Fourth Term
Oregon Gov. John Kitzhaber (D) will seek a fourth four-year term in office, he said Monday, kicking off a campaign likely to be dominated by health care and tax reform. … Kitzhaber said Monday he would focus his campaign on education, implementation of health care reform, reducing the state’s carbon output and creating new middle class jobs. Health care reform could prove a headache for the Democrat, who spearheaded the charge for a state-run portal that has been beset by technical problems. The Cover Oregon Web site has enrolled just 8,300 people after a rocky rollout stymied residents eager to sign up. Last week, Cover Oregon’s executive director, who had been under fire for the glitches, said he would take a leave of absence for medical reasons (Wilson, 12/9).

USA Today: Oregon Gov Expects ‘Slings And Arrows’ On Health Care
Could the rocky rollout of an online health care exchange be a factor in a񎧞 election? We’re not talking about a race for Congress, but the race for governor in Oregon — where Democratic incumbent John Kitzhaber announced Monday he will seek an unprecedented fourth term. Kitzhaber, who has already made Oregon history with his third term in office, said he expects to take “a few slings and arrows about the rocky rollout” of the Cover Oregon online insurance exchange (Camia, 12/9). 

Meanwhile, the Wall Street Journal looks at the Oregon website’s problems.

The Wall Street Journal’s CIO Journal: Cover Oregon CIO: Integrating Oracle Software Is ‘Daunting’
More than two months after the Obamacare online health exchanges launched, Oregon has yet to enroll a single person online through its state exchange. The site’s tech leader cited the challenges integrating primary contractor Oracle Corp.’s software as well as missed deadlines by the software maker and the state’s own failure to hire a systems integrator as key reasons for Cover Oregon’s continued dysfunction. These challenges, which persist today, mean the exchange won’t be fully operational until after Jan. 1, 2014 (Boulton, 12/9).

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John Podesta Reportedly Ready To Join White House Team

Former aide to President Bill Clinton expected to help President Barack Obama as he seeks to recover public support on health law.

The New York Times: Ex-Clinton Aide Expected To Join Obama
President Obama, after a rocky year that leaves him at the lowest ebb of his presidency, is bringing into his White House circle the longtime Democratic strategist John D. Podesta, a former chief of staff for President Bill Clinton. … Word that Mr. Podesta would for the first time join Mr. Obama’s official staff, from people familiar with the discussions, comes as the president is seeking to recover public support and credibility after the flawed introduction in October of the insurance marketplaces that are a key part of his signature Affordable Care Act. This week he brought back his former chief congressional lobbyist, Phil Schiliro, who had moved to New Mexico, to help on the health care issues (Calmes, 12/9).

Politico: Podesta To Advise Obama
Podesta will return to the White House as Obama struggles to regain his credibility after the troubled rollout of HealthCare.gov. The president has already recalled Phil Schiliro, a former legislative affairs director, to serve as the White House’s point person on Obamacare policy. Podesta is viewed as a hand so trusted and widely perceived as an honest broker in Democratic circles that he would have run the presidential transition of either Barack Obama or Hillary Clinton in 2008 (Budoff Brown, 12/9).

Meanwhile, another Obama administration nominee will be questioned by a Senate panel about the health law.

The Associated Press: IRS Nominee To Face Questions On Health Law
President Barack Obama’s choice to head the Internal Revenue Service goes before a Senate committee Tuesday to face tough questions about the agency’s targeting of tea party groups and its ability to administer parts of the president’s health law. Obama nominated John Koskinen, a retired corporate and government official with experience managing numerous organizations in crisis, to take over the IRS in August. If confirmed by the Senate, the 74-year-old turnaround specialist would sign on to a five-year term, which would last beyond Obama’s stay in office (Ohlemacher, 12/10).

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