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Nurse Visits Help First-Time Moms, Cut Government Costs In Long Run

Thu, 05/14/2015 - 3:23pm
Nurse Visits Help First-Time Moms, Cut Government Costs In Long Run May 14, 2015 3:23 PM ET

Partner content from

Michelle Andrews

Symphonie Dawson and her son, Andrew. A visiting nurse program helped Dawson finish school while she was pregnant.

Courtesy of Symphonie Dawson

While studying to become a paralegal and working as a temp, Symphonie Dawson kept feeling sick. She found out it was because she was pregnant.

Living with her mom and two siblings near Dallas, Dawson, then 23, worried about what to expect during pregnancy and what giving birth would be like. She also didn't know how she would juggle having a baby with being in school.

At a prenatal visit she learned about a group that offers help for first-time mothers-to-be called the Nurse-Family Partnership. A registered nurse named Ashley Bradley began to visit Dawson at home every week to talk with her about her hopes and fears about pregnancy and parenthood.

Bradley helped Dawson sign up for the Women, Infants and Children Program, which provides nutritional assistance to low-income pregnant women and children. They talked about what to expect every month during pregnancy and watched videos about giving birth. After her son Andrew was born in December 2013, Bradley helped Dawson figure out how to manage her time so she wouldn't fall behind at school.

Dawson graduated with a bachelor's degree in early May. She's looking forward to spending time with Andrew and finding a paralegal job. She and Andrew's father recently became engaged.

Ashley Bradley will keep visiting Dawson until Andrew turns 2.

"Ashley's always been such a great help," Dawson says. "Whenever I have a question like what he should be doing at this age, she has the answers."

Home-visiting programs that help low-income, first-time mothers have been around for decades. Lately, however, they're attracting new fans. They appeal to people of all political stripes because the good ones manage to help families improve their lives and reduce government spending at the same time.

In 2010, the Affordable Care Act created the Maternal, Infant and Early Childhood Home Visiting program and provided $1.5 billion in funding for evidence-based home visits. As a result, there are now 17 home visiting models approved by the Department of Health and Human Services, and Congress reauthorized the program in April with $800 million for the next two years.

The Nurse-Family Partnership that helped Dawson is one of the largest and best-studied programs. Decades of research into how families fare after participating in it have documented reductions in the use of social programs such as Medicaid and food stamps, reductions in child abuse and neglect, better pregnancy outcomes for mothers and better language development and academic performance by their children.

"Seeing follow-up studies 15 years out with enduring outcomes, that's what really gave policymakers comfort," says Karen Howard, vice president for early childhood policy at First Focus, an advocacy group.

But others say the requirements for evidence-based programs are too lenient, and that only a handful of the approved models have as strong a track record as that of the Nurse-Family Partnership.

"If the evidence requirement stays as it is, almost any program will be able to qualify," says Jon Baron, vice president for of evidence-based policy at the Laura and John Arnold Foundation, which supports initiatives that encourage policymakers to make decisions based on data and other reliable evidence. "It threatens to derail the program."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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A Fungus Causes More Unexpected Illnesses In Montana

Thu, 05/14/2015 - 12:50pm
A Fungus Causes More Unexpected Illnesses In Montana May 14, 201512:50 PM ET

Cough? Check. Fever? Check. But bet you didn't think that this common fungus, Histoplasma capsulatum, could be making you sick.

Science Source

If you go to the doctor with a cough and fever, odds are you're not thinking you could have an unusual fungal infection — and neither is the doctor.

That's why the Centers for Disease Control and Prevention wants to get the word out that they found more people sick with histoplasmosis in Montana and Idaho.

When we first heard about people out West getting histoplasmosis back in 2013, it was one of those gee-whiz infectious disease stories. The Histoplasma fungus is common in the Mississippi and Ohio River valleys, but infectious disease doctors hadn't seen it causing illness in Montana before. It could have been a fluke, they figured. Maybe people had gotten infected while traveling out of state.

Shots - Health News Dangerous Fungus Makes A Surprise Appearance In Montana

But now they're reporting two more cases, bringing the total to five in Montana and one in Idaho. Three people were sick enough to be hospitalized; one died. The cases were reported Thursday in Emerging Infectious Diseases.

If you happen to be living in the Intermountain West there's no need to freak out, says Dr. Randall Nett, a medical officer for the CDC in Helena, Mont., and lead author of the report. There are medications that work on histoplasmosis, but doctors need to realize it can be the cause of pneumonia-like symptoms. "It's a very difficult disease to diagnose because it kind of mimics many other things," he tells Shots.

Half of these people had been sick for more than six months before they were correctly diagnosed, Nett says. A urine test detects it.

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The Histoplasma fungus likes to hang out in soil, especially with bird or bat droppings. Four of the six people who fell ill had been doing things that increased their risk of infection, including working with potting soil, exploring caves and cleaning pigeon cages.

Most people who breathe in spores never get sick, the CDC says. But having other health issues ups the risk of life-threatening illness. Five of the six people had other health problems, including Type 2 diabetes, hepatitis C and active mononucleosis.

"We would ask folks in the community to be aware if they have a compromised immune system," Nett says. "They should avoid high-risk activities." That includes spelunking, demolishing buildings or other activities that kick up a lot of dust.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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A Database Of All Things Brainy

Thu, 05/14/2015 - 3:34am
A Database Of All Things Brainy May 14, 2015 3:34 AM ET Listen to the Story 2:01
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The Allen Cell Types Database catalogs all sorts of details about each type of brain cell, including its shape and electrical activity. These cells, taken from the visual area of a mouse brain, are colored according to the patterns of electrical activity they produce.

Courtesy of Allen Institute for Brain Science

When the brain needs to remember a phone number or learn a new dance step, it creates a circuit by connecting different types of neurons.

"The fact that you remember very specific things — that first summer day when you kissed your first girl — that is due to the great specificity of your neural circuits. So that's what we have to understand."

Scientists still don't know how many types of neurons there are or exactly what each type does.

"How are we supposed to understand the brain and help doctors figure out what schizophrenia is or what paranoia is when we don't even know the different components?" says Christof Koch, president and chief scientific officer of the Allen Institute for Brain Science, a nonprofit research center in Seattle.

So the institute is creating a freely available online database that eventually will include thousands of nerve cells. For now, the Allen Cell Types Database has detailed information on 240 mouse cells, including their distinctive shapes.

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"They look like different trees," Koch says. "Some fan out at the top. Some are like a Christmas tree; they fan out at the bottom. Others are like three-dimensional fuzz balls."

The database also describes each cell by the electrical pattern it generates. And eventually it will include information about which genes are expressed.

Once researchers have a complete inventory of details about the brain's building blocks, they'll need to know which combinations of blocks can be connected, Koch says. After all, he says, it is these connections that make us who we are.

"The fact that you remember very specific things — that first summer day when you kissed your first girl — that is due to the great specificity of your neural circuits," Koch says. "So that's what we have to understand."

The Allen Institute plans to release a database of different types of human brain cells next year.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Long-Term Depression May Boost Stroke Risk Long After Mood Improves

Thu, 05/14/2015 - 3:32am
Long-Term Depression May Boost Stroke Risk Long After Mood Improves May 14, 2015 3:32 AM ET Listen to the Story 3:45
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Medical researchers have known for several years that there is some sort of link between long-term depression and an increased risk of stroke. But now scientists are finding that even after such depression eases, the risk of stroke can remain high.

"We thought that once people's depressive symptoms got better their stroke risk would go back down to the same as somebody who'd never been depressed," says epidemiologist Maria Glymour, who led the study when she was at Harvard's T.H. Chan School of Public Health. But that's not what her team found.

Even two years after their chronic depression lifted, Glymour says, a person's risk for stroke was 66 percent higher than it was for someone who had not experienced depression.

The study analyzed data across a dozen years for more than 16,000 adults, age 50 or older. Participants were asked to complete a survey every two years from 1998 to 2010 that asked, among other things, about their mood the previous week.

Mental Health Working Through Depression: Many Stay On The Job, Despite Mental Illness

The questions, Glymour says, included whether "during the past week, they had often felt depressed; felt that everything they did was an effort; whether they had had restless sleep; they felt lonely; whether they couldn't 'get going'; whether they felt sad."

If people answered "yes" to three or more of these questions, the researchers counted them depressed. The scientists also kept track of whether participants had a stroke during the 12-year study period.

Now, Glymour expected people with long-term depression to have a higher risk of stroke. And they did — more than double the risk of those who weren't depressed. But she was not expecting stroke risk to continue as long as two years after the depression lifted.

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Scientists don't yet know the mechanisms involved, she says — why depression would predispose someone to stroke. It could have something to do with the body's physical reaction to the psychological malady, Glymour says.

"Changes in immune function," she says, "[or] inflammatory response, nervous system functioning — all of these might influence blood pressure [or] cortisol levels and thereby increase your risk of stroke."

It's also possible, she says, that depression changes a person's behavior in ways that increase the risk of stroke. People may be more likely to smoke cigarettes or drink excessive amounts of alcohol when depressed, or find it harder to get exercise.

Glymour says the study's findings imply that the negative health effects of depression are likely cumulative over time — people whose diagnosis of depression was very recent were not more likely to have a stroke than people who never had symptoms.

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That's one more reason why it's so very important to treat depression as soon as possible, she says. Dr. Renee Binder with the American Psychiatric Association agrees.

"There is no health without mental health," Binder says, adding that people should be routinely screened for depression and anxiety when they see their primary care provider.

The answers to just a few questions — such as whether patients feel sad many days of the week or get pleasure from everyday activities — can be clear warning signs that more extensive screening is needed, maybe including a referral to a mental health specialist.

The good news, Binder says, is that depression can be "extremely treatable" once it's addressed. A short course of psychotherapy or a short course of medication, she says, can quickly turn things around in many cases.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Smokers More Likely To Quit If Their Own Cash Is On The Line

Wed, 05/13/2015 - 5:50pm
Smokers More Likely To Quit If Their Own Cash Is On The Line May 13, 2015 5:50 PM ET Listen to the Story 3:55
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A new study finds that employer-based programs to help people stop smoking would work better if they tapped into highly motivating feelings — such as the fear of losing money.

This conclusion flows from a study involving the employees of CVS/Caremark. Some workers got postcards asking them if they wanted a cash reward to quit smoking. One card ended up in the hands of Camelia Escarcega in Rialto, Calif., whose sister works for CVS.

Escarcega says she had smoked for many years and wanted to quit, and figured money would be a good incentive. Her sister told her she was welcome to enroll in the study, so she did.

"People are much more afraid of losing $5 than they are motivated to earn $5. And so people's actions go with their psychology."

Escarcega didn't know it at the time, but the study was comparing different financial incentives to help people quit smoking. Hers was straightforward: Over a span of six months, she'd get up to $800 if she quit and didn't start again.

She did pretty well, she says. "I've been smoke-free for a year and a half now." The program offered her free nicotine patches, but Escarcega says she didn't even need that added help.

Dr. Scott Halpern, a professor of medicine, epidemiology, medical ethics and health policy at the University of Pennsylvania, worked with colleagues to design the study, as a way of exploring the best way to entice people to quit tobacco, using financial incentives.

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"A dollar is not a dollar," Halpern says, "and how you design smoking cessation programs of the same approximate value goes a long way toward determining how effective these programs will be."

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The researchers compared a few approaches. Some people simply got cash for quitting. Others were offered a carrot-and-stick approach. They'd get a similar financial reward if they quit, but they'd also lose $150 of their own money if they started smoking again.

"People are much more afraid of losing $5 than they are motivated to earn $5," Halpern says. "And so people's actions go with their psychology."

It came as no surprise that the researchers found it a lot harder to convince people to put down a deposit of their own money. But when they did, the results were remarkable.

"The deposit programs were twice as effective as rewards, and five times more effective than providing free smoking cessation aids like nicotine replacement therapy," Halpern says.

More than half of the people who had money on the line stopped smoking for at least six months. These results are reported Wednesday in the latest New England Journal of Medicine. And Halpern argues the approach is much more effective than what most companies do now.

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"Many programs are structured such that employees who stop smoking are rewarded by having less money taken out of their paychecks for insurance premiums the following year," Halpern notes. "But by bundling the rewards into paychecks they're relatively invisible to people — and the fact that they occur in the future — makes it less influential than if people were handed the same amount of money more quickly."

Mercer, a benefits consulting company, reports that 21 percent of large employers currently offer financial incentives to workers who quit smoking or don't start — primarily by reducing their health-insurance premiums. (An additional 5 percent of those companies offer other incentives). And more than half of the nation's biggest employers use incentives.

Halpern says insurance premium rebates aren't the best way to go.

"Employers and insurers could do a whole lot more to curb smoking than they currently are," he says. "And doing so, they would reduce costs to themselves and improve public health." Each employee who smokes costs a company more than $5,000 extra a year, due to health care costs and other expenses.

This is potentially tricky ground to navigate, though.

"Companies may have a concern that if they sign people into this kind of a wellness program and [the employees] lose that deposit, they're going to feel really badly," says Oleg Urminsky, at the University of Chicago's Booth School of Business.

The worry is that those bad feelings "may spill into other things," Urminsky says. "Are they going to resent the employer? Are they going to be complaining? It's a powerful tool but it's one that has to be used carefully."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Why Would A Fish Make Its Own Sunscreen?

Wed, 05/13/2015 - 3:16pm
Why Would A Fish Make Its Own Sunscreen? May 13, 2015 3:16 PM ET

The lowly zebra fish can make its own sunscreen.

Marrabbio2/Wikimedia Commons

Creatures that venture out into the daylight can be damaged by the sun's ultraviolet rays. Humans produce melanin, a dark pigment, to help protect our skin. And now many of us slather on sunscreen, too.

Bacteria, algae and fungi make their own chemicals that sop up UV rays. And there's one called gadusol that's been found in fish and their eggs.

Scientists at Oregon State University say they've found that zebra fish, a popular species for lab work, can produce gadusol on their own. Until now, many thought fish got the stuff by eating bacteria and algae that made it.

But why would fish make gadusol?

"We know that gadusol has anti-UV properties, sunscreen properties," says Taifo Mahmud, a medicinal chemist at Oregon State's pharmacy school. Still, he says it's not entirely clear if animals such as zebra fish would make it for reasons other than UV protection.

It's possible that gadusol, an antioxidant, might have other uses. In zebra fish, gadusol is produced in significant quantities during the development of embryos.

Mahmud's team found that the genes zebra fish use to make gadusol are different from the ones that microbes use.

After searching the genomes of many different animals, Mahmud's team identified gadusol-producing genes like the zebra fish's in amphibians, reptiles and birds. They didn't find them in mammals or coelacanths, the ancient fish that were only known as fossils before they were discovered alive in 1938.

The group's findings, published Tuesday in the journal eLife, suggest that the genes (called EEVS and MT-Ox) were carried by a common animal ancestor hundreds of millions of years ago that some later creatures, such as zebra fish, preserved while others did not.

eLife

Where did the genes come from? Well, they look more like those found in algae than bacteria. So the Oregon State group's paper suggest that there may have been a jump of the genes from algae to the common animal ancestor way back when. These so-called horizontal transfers are common in lower organisms and may account for quite a few genes in the human genome, too.

"Overall, this work illuminates a novel pathway that constructs an important biological sunscreen, but it also raises a number of questions," two Harvard chemists wrote in an accompanying analysis of the gadusol paper. How exactly did the cluster of genes evolve in animals and why did some lose them? And what biological purpose does the sunscreen chemical actually serve?

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Here's A Radical Approach To Big Hospital Bills: Set Your Own Price

Wed, 05/13/2015 - 10:09am
Here's A Radical Approach To Big Hospital Bills: Set Your Own Price May 13, 201510:09 AM ET

Partner content from

Jay Hancock

In the late 1990s you could have taken what hospitals charged to administer inpatient chemotherapy and bought a Ford Escort econobox. Today, average charges for chemo, not even counting the price of the anti-cancer drugs, are enough to pay for a Lexus GX sport-utility vehicle.

Hospital prices have risen nearly three times as much as overall inflation since Ronald Reagan was president. Health payers have tried HMOs, accountable care organizations and other innovations in efforts to control them, with little effect.

A small benefits consulting firm called ELAP Services is causing a commotion by suggesting an alternative: Refuse to pay.

When hospitals send invoices with charges that seem to bear no relationship to their costs, the Pennsylvania firm tells its clients, generally medium-sized employers, to just say no.

Instead, employers pay hospitals a much lower amount for their services, based on ELAP's analysis of what is reasonable after analyzing the hospitals' own financial filings.

"This is the best form of true health care reform that I've come across."

For facilities on the receiving end of ELAP's unusual strategy, this is a disruption of business as usual, to say the least. Hospitals are unhappy, but have failed to make headway against it in court.

"It was a leap of faith" when Huffines Auto Dealerships signed on to the ELAP plan a few years ago, says Eric Hartter, chief financial officer for the Texas firm. Now he says: "This is the best form of true health care reform that I've come across."

Huffines, which provides coverage to 300 employees and their families, first worked with ELAP on charges for an employee's back surgery. The worker had spent three days in a Dallas hospital. The bill was $600,000, Hartter said.

Like many businesses, the dealership pays worker health costs directly. At the time it was working with a claims administrator that set up a traditional "preferred provider" network with agreed-upon hospital discounts.

The administrator looked at the bill and said, "'Don't worry. By the time we apply the discounts and everything else it'll be down to about $300,000,' " Hartter recalled. "I said, 'What's the difference? That doesn't make me feel any better.' "

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So he had ELAP analyze the bill. The firm estimated costs for the treatment based on the hospital's financial reports filed with Medicare. Then it added a cushion so the hospital could make a modest profit.

"We wrote a check to the hospital for $28,900 and we never heard from them again," Hartter says.

Now Huffines and ELAP, which launched this service in 2007, treat every big hospital bill the same way. It has saved so much money for the dealership that the amount that the company and its workers pay for health costs has stayed unchanged for six years, Hartter says. And benefits remained the same.

More than 200 employers that provide health coverage to about 115,000 workers and dependents have hired ELAP, the company says. Company CEO Steve Kelly says he is aware of only one other smaller benefits consultant with the same approach.

Normally customers who don't pay bills get hassled or sued. This sometimes happens to ELAP clients and their workers. Hospitals send patients huge invoices for what the employer refused to pay. They hire collection agents and threaten credit scores.

"We wrote a check to the hospital for $28,900 and we never heard from them again."

ELAP fights back with lawyers and several arguments: How can hospitals justifiably charge employers and their workers so much more than they accept from Medicare, the government program for seniors? How can hospitals bill $30 for a gauze pad? How can patients consent to prices they will never see until after they've been discharged?

The American Hospital Association and the Federation of American Hospitals did not respond to requests for comment about ELAP.

ELAP is not merely a medical-bill auditor, like many other companies that comb hospital statements for errors. It sets the reimbursement, telling hospitals what clients will pay.

"Overwhelmingly, the providers just accept the payment" and leave patients alone, Kelly said. A federal district judge in Georgia decided a 2012 case against a hospital and in favor of ELAP and its furniture chain client.

Most patients being dunned by hospitals are unlikely to meet with the same success on their own, lacking backup from ELAP and its legal firepower.

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Under ELAP's main model, neither employers nor their claims administrators sign contracts with hospitals. Employers detail the reimbursement process in documents establishing how the plan covers workers. That gives it legal weight, ELAP has argued in court. ELAP agrees to handle all hospital bills for an employer and to defend workers from collections in return for a percentage fee tied to total hospital charges.

There is no hospital network. Employees may use almost any facility. Payments are made later based on ELAP's analysis.

That may change, Kelly says. Often it makes sense even for medium-sized employers to contract directly with hospitals to treat their workers, he said. That way prices are clear.

But for now, ELAP clients such as Huffines and IBT Industrial Solutions are giving hospitals a different dose of medicine.

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At IBT, a Kansas distributor of bearings and motors, "runaway health costs were starting to threaten the long-term viability of our company," says chief financial officer Greg Drown. After reading "Bitter Pill," a Time magazine piece critical of health-care costs, IBT executives decided to try something else.

They hired ELAP, which was "not a simple or risk-free move," cautions Drown.

About one IBT worker in five using a hospital gets "balance billed" for amounts the employer refuses to pay, Drown says. That can take months to resolve even with ELAP's legal support. But ELAP's program cut health costs by about one quarter, he says.

Recently managers at a big medical system in metro Kansas City "finally figured out we were doing something a little bit different," sent "a nasty letter" and followed up with a call, he said.

The hospital executive on the phone "was very condescending and thought I was stupid and had been duped by a predatory consultant and had been sold a, quote, crappy plan," Drown said.

Drown listened. He told the man he would consult with his colleagues and reply.

"I called him back a week or two later and left him a rather detailed voicemail that said, 'We're not changing anything. We're staying where we are.' And the guy never called me back."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
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Seasons May Tweak Genes That Trigger Some Chronic Diseases

Tue, 05/12/2015 - 1:10pm
Seasons May Tweak Genes That Trigger Some Chronic Diseases May 12, 2015 1:10 PM ET Listen to the Story 4:13
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The seasons appear to influence when certain genes are active, with those associated with inflammation being more active in the winter, according to new research released Tuesday.

A study involving more than 16,000 people found that the activity of about 4,000 of those genes appears to be affected by the season, researchers reported in the journal Nature Communications. The findings could help explain why certain diseases are more likely than others to strike for the first time during certain seasons, the researchers say.

"One of the standout results was that genes promoting inflammation were increased in winter, whereas genes suppressing inflammation were decreased in the winter."

"Certain chronic diseases are very seasonal — like seasonal affective disorder or cardiovascular disease or Type 1 diabetes or multiple sclerosis or rheumatoid arthritis," says John Todd, a geneticist at the University of Cambridge who led the research. "But people have been wondering for decades what the explanation for that is."

Todd and his colleagues decided to try to find out. They analyzed the genes in cells from more than 16,000 people in five countries, including the United States and European countries in the Northern Hemisphere, and Australia in the Southern Hemisphere. And they spotted the same trend — in both hemispheres, and among men as well as women.

"It's one of those observations where ... the first time you see it, you go, 'Wow, somebody must have seen this before,' " Todd says.

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When the researchers looked more closely at which genes were more or less active during some seasons than others, one big thing jumped out.

"One of the standout results was that genes promoting inflammation were increased in winter, whereas genes suppressing inflammation were decreased in the winter. So overall it looked as if this gene activity pattern really goes with increased inflammation in the winter," he says.

Inflammation, which is caused by the immune system becoming overactive, Todd says, has long been associated with a lot of the health problems that spike in the winter.

No one knows how the seasons affect our genes. But there are some obvious possibilities, Todd thinks.

"As the seasons come on it gets colder, the days get shorter," he says. "So daylight and temperature could be factors."

Other researchers say the findings could have far-reaching implications.

"The fact that they find so many genes that go up and down over the seasons is very interesting because we just didn't know that our bodies go through this type of seasonal change before," says Akhilesh Reddy, who studies circadian rhythms at the University of Cambridge but was not involved in the new research. "And if you look at the actual genetic evidence for the first time, it's pretty profound really."

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Reddy thinks the findings will prompt other scientists to look into how the seasons may have power over our genes.

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"People might have a variation in their responses to all sorts of things that we haven't really thought about yet," Reddy says.

For example, the seasons may affect how people metabolize drugs.

"Even your cognitive performance ... might be influenced subtly by the time of year at which you're assessed," he says. "There's never been a marker before that you can look at in the blood, or whatever, to say, 'You're looking like you're a winter person now versus a summer person.' "

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
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Seasons May Tweak Genes That Trigger Some Chronic Diseases

Tue, 05/12/2015 - 1:10pm
Seasons May Tweak Genes That Trigger Some Chronic Diseases May 12, 2015 1:10 PM ET

The seasons appear to influence when certain genes are active, with those associated with inflammation being more active in the winter, according to new research released Tuesday.

A study involving more than 16,000 people found that the activity of about 4,000 of those genes appears to be affected by the season, researchers reported in the journal Nature Communications. The findings could help explain why certain diseases are more likely to strike for the first time during certain seasons than others, the researchers say.

"One of the standout results was that genes promoting inflammation were increased in winter, whereas genes suppressing inflammation were decreased in the winter."

"Certain chronic diseases are very seasonal — like seasonal affective disorder or cardiovascular disease or Type 1 diabetes or multiple sclerosis or rheumatoid arthritis," says John Todd, a geneticist at the University of Cambridge, who led the research. "But people have been wondering for decades what the explanation for that is."

So Todd and his colleagues decided to try to find out. They analyzed the genes in cells from more than 16,000 people in five countries, including the United States and European countries in the Northern Hemisphere, and Australia in the Southern Hemisphere. And they spotted the same trend — in both hemispheres, and among men as well as women.

"It's one of those observations where ... the first time you see it, you go, 'Wow, somebody must have seen this before,' " Todd says.

Shots - Health News Why Keeping Little Girls Squeaky Clean Could Make Them Sick

When the researchers looked more closely at which genes were more or less active during some seasons than others, one big thing jumped out.

"One of the standout results was that genes promoting inflammation were increased in winter, whereas genes suppressing inflammation were decreased in the winter. So overall it looked as if this gene activity pattern really goes with increased inflammation in the winter," he says.

Inflammation, which is caused by the immune system becoming overactive, Todd says, has long been associated with a lot of the health problems that spike in the winter.

No one knows how the seasons affect our genes. But there are some obvious possibilities, Todd thinks.

"As the seasons come on it gets colder, the days get shorter," he says. "So daylight and temperature could be factors."

Other researchers say the findings could have far-reaching implications.

"The fact that they find so many genes that go up and down over the seasons is very interesting because we just didn't know that our bodies go through this type of seasonal change before," says Akhilesh Reddy, who studies circadian rhythms at the University of Cambridge but was not involved in the new research. "And if you look at the actual genetic evidence for the first time, it's pretty profound really."

Shots - Health News Obesity Stokes Rheumatoid Arthritis With More Than Just Extra Weight

Reddy thinks the findings will prompt other scientists to look into how the seasons may have power over our genes.

Goats and Soda A Virus In Your Mouth Helps Fight The Flu

"People might have a variation in their responses to all sorts of things that we haven't really thought about yet," Reddy says.

For example, the seasons may affect how people metabolize drugs.

"Even your cognitive performance ... might be influenced subtly by the time of year at which you're assessed," he says. "There's never been a marker before that you can look at in the blood, or whatever, to say, 'You're looking like you're a winter person now versus a summer person.' "

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Short On Sleep? You Could Be A Disaster Waiting To Happen

Tue, 05/12/2015 - 1:04pm
Short On Sleep? You Could Be A Disaster Waiting To Happen May 12, 2015 1:04 PM ET

Workers try to remove some of the 11 million gallons of oil spilled by the Exxon Valdez off Alaska in 1989. The ship's third mate may have been up for 18 hours before the accident.

Rob Stapleton/AP

Missing out on sleep pretty much guarantees feeling crummy the next day. But it can also lead to dangerous or even disastrous decision-making. Sleep-deprived operators failed to prevent the Chernobyl nuclear power plant meltdown and the Exxon Valdez oil spill.

And during the Civil War, some historians think that Confederate Gen. Stonewall Jackson's confused command during the battles of June 1862 was due to sleep deprivation.

When we lose sleep, it seems we lose our ability to think on our feet — to take in new information and adjust our behavior, according to a study published in the June issue of the journal Sleep.

Researchers at Washington State University figured this out by rounding up 26 volunteers. Half went without any sleep for two days, while the other half slept normal hours. Over the course of a week, the scientists tested everyone's ability to complete decision-making tests.

In one test, the volunteers had to click a button when they saw certain numbers and hold back when they saw others. Then the rule was switched.

The well-rested group did better on this task in general. But when the rule was reversed, none of the sleep-deprived volunteers were able to get the right answer — even after 40 tries.

Shots - Health News Skimping On Sleep Can Stress Body And Brain

"It wasn't just that sleep-deprived people were slower to recover," says Paul Whitney, a psychologist at the university who led the study. "Their ability to take in new information and adjust was completely devastated."

Whitney says sleep scientists still don't understand why this happens. But it looks like the lack of sleep may be dulling the nervous system's response to new information. They found this out by hooking up the volunteers to electrodes that tracked their bodies' response to stimuli.

"Normally, the machine will pick up when people have a strong negative or positive response to something," Whitney says. "And we found that for the sleep-deprived group, the machine wasn't picking up much. Their reactions were completely blunted," Whitney says.

Sleep loss didn't affect all types of thinking. Everyone did pretty well on tasks that tested short-term memory, though the well-rested people did slightly better.

Since we can function fairly well in some aspects without sleep, people often don't realize just how much sleep deprivation can impair them, Whitney says.

If you can, he says, avoid making any high-stakes decisions when you're short of sleep, he says. And if you don't have a choice, take some extra time to make sure you're considering all the factors.

Shots - Health News For A Good Snooze, Take One Melatonin, Add Eye Mask And Earplugs

"The implication here is you should know that the most likely error you'll make when you haven't slept is that you're not going to second-guess yourself as much as you probably should," he says.

Of course, this is only a preliminary study — it's one of the first to test how sleep affects high-level decision-making. And while the study subjects were up for two consecutive days, in real-world situations people are more likely to get inadequate sleep over a long period of time, rather than no sleep over a short period.

Previous studies have shown that the effects of chronic sleep loss are similar to the acute sleep deprivation the subjects of this study experienced, Whitney says.

"It's hard to simulate in a lab the kind of decision-making that is predictive of what happens in a natural, real-world situation," says Charles Czeisler, head of the Division of Sleep and Circadian Disorders at Brigham and Women's Hospital and chairman of the board of the National Sleep Foundation, who wasn't involved in the recent research. "But this study does a really good job of getting at that."

It scientifically proves what we've known for a while — in high-stakes situations, sleep loss can be disastrous. "There have been many situations throughout history, particularly in military battles, where very highly capable individuals made mistakes when they were exhausted," Czeisler says. "This shows that when we practice disaster preparedness, we should think about how are we're going to rotate command-and-control."

And sleep is important even when you're not making life-or-death decisions, he adds. "People are increasingly burning the candle at both ends. And that's really not a good idea. It can even be dangerous."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Short On Sleep? You Could Be A Disaster Waiting To Happen

Tue, 05/12/2015 - 1:04pm
Short On Sleep? You Could Be A Disaster Waiting To Happen May 12, 2015 1:04 PM ET

Workers try to remove some of the 11 million gallons of oil spilled by the Exxon Valdez off Alaska in 1989. The ship's third mate may have been up for 18 hours before the accident.

Rob Stapleton/AP

Missing out on sleep pretty much guarantees feeling crummy the next day. But it can also lead to dangerous or even disastrous decision-making. Sleep-deprived operators failed to prevent the Chernobyl nuclear power plant meltdown and the Exxon Valdez oil spill.

And during the Civil War, Confederate Gen. Stonewall Jackson was famously running on two hours of sleep when he made a series of tactical errors and was ultimately shot by friendly fire.

When we lose sleep, it seems we lose our ability to think on our feet — to take in new information and adjust our behavior, according to a study published in the June issue of the journal Sleep.

Researchers at Washington State University figured this out by rounding up 26 volunteers. Half went without any sleep for two days, while the other half slept normal hours. Over the course of a week, the scientists tested everyone's ability to complete decision-making tests.

In one test, the volunteers had to click a button when they saw certain numbers and hold back when they saw others. Then the rule was switched.

The well-rested group did better on this task in general. But when the rule was reversed, none of the sleep-deprived volunteers were able to get the right answer — even after 40 tries.

Shots - Health News Skimping On Sleep Can Stress Body And Brain

"It wasn't just that sleep-deprived people were slower to recover," says Paul Whitney, a psychologist at the university who led the study. "Their ability to take in new information and adjust was completely devastated."

Whitney says sleep scientists still don't understand why this happens. But it looks like the lack of sleep may be dulling the nervous system's response to new information. They found this out by hooking up the volunteers to electrodes that tracked their bodies' response to stimuli.

"Normally, the machine will pick up when people have a strong negative or positive response to something," Whitney says. "And we found that for the sleep-deprived group, the machine wasn't picking up much. Their reactions were completely blunted," Whitney says.

Sleep loss didn't affect all types of thinking. Everyone did pretty well on tasks that tested short-term memory, though the well-rested people did slightly better.

Since we can function fairly well in some aspects without sleep, people often don't realize just how much sleep deprivation can impair them, Whitney says.

If you can, he says, avoid making any high-stakes decisions when you're short of sleep, he says. And if you don't have a choice, take some extra time to make sure you're considering all the factors.

Shots - Health News For A Good Snooze, Take One Melatonin, Add Eye Mask And Earplugs

"The implication here is you should know that the most likely error you'll make when you haven't slept is that you're not going to second-guess yourself as much as you probably should," he says.

Of course, this is only a preliminary study — it's one of the first to test how sleep affects high-level decision-making. And while the study subjects were up for two consecutive days, in real-world situations people are more likely to get inadequate sleep over a long period of time, rather than no sleep over a short period.

Previous studies have shown that the effects of chronic sleep loss are similar to the acute sleep deprivation the subjects of this study experienced, Whitney says.

"It's hard to simulate in a lab the kind of decision-making that is predictive of what happens in a natural, real-world situation," says Charles Czeisler, head of the Division of Sleep and Circadian Disorders at Brigham and Women's Hospital and chairman of the board of the National Sleep Foundation, who wasn't involved in the recent research. "But this study does a really good job of getting at that."

It scientifically proves what we've known for a while — in high-stakes situations, sleep loss can be disastrous. "There have been many situations throughout history, particularly in military battles, where very highly capable individuals made mistakes when they were exhausted," Czeisler says. "This shows that when we practice disaster preparedness, we should think about how are we're going to rotate command-and-control."

And sleep is important even when you're not making life-or-death decisions, he adds. "People are increasingly burning the candle at both ends. And that's really not a good idea. It can even be dangerous."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Free Contraceptives Must Be Free, Obama Administration Tells Insurers

Tue, 05/12/2015 - 11:06am
Free Contraceptives Must Be Free, Obama Administration Tells Insurers May 12, 201511:06 AM ET

Partner content from

Phil Galewitz

If the Food and Drug Administration has approved a type of prescription contraception, then insurers must cover at least one option at no cost to the consumer.

BSIP/Science Source

Free means free.

The Obama administration said Monday that health plans must offer at least one option for every type of prescription birth control free of charge to consumers. The instructions clarify the Affordable Care Act's contraceptive mandate.

"Today's guidance seeks to eliminate any ambiguity," the Health and Human Services Department said. "Insurers must cover without cost-sharing at least one form of contraception in each of the methods that the Food and Drug Administration has identified ... including the ring, the patch and intrauterine devices."

The ruling comes after reports by the Kaiser Family Foundation and the National Women's Law Center, an advocacy group, that many insurers were not providing no-cost birth control for all prescription methods. (KHN is an editorially independent project of the Kaiser Family Foundation.)

Gretchen Borchelt, a vice president with the women's law center, applauded the guidance. "Insurance companies have been breaking the law, and today, the Obama administration underscored that it will not tolerate these violations," she said. "It is now absolutely clear that 'all' means 'all' — 'all' unique birth control methods for women must be covered."

The law requires that preventive services, such as contraception and well-woman visits, be covered without out-of-pocket expenses, such as a copay or deductible.

While HHS said insurers must offer free at least one version of all 18 FDA-approved contraceptives, the plans may still charge fees to encourage individuals to use a particular brand or generic. For example, a generic form might be free, while a brand-name version of the drug can include cost-sharing, HHS said.

The administration Monday said insurers could have misinterpreted prior rules to mean they only had to offer certain types of contraception without cost-sharing. Plans have until July to implement the policy, which won't generally take effect until a new plan year begins, which is January for most people.

Karen Ignagni, CEO of trade group America's Health Insurance Plans, said she was pleased the guidance allows insurers to practice "medical management." In other works, insurers can charge a copay or deductible for some birth control rather than having to provide all brands free.

Cecile Richards, president of Planned Parenthood Action Fund, the political arm of Planned Parenthood of America, praised the move. "This is a victory for women and the more than 30,000 Planned Parenthood supporters who spoke out to ensure all women, no matter what insurance they have, can access the full range of birth control methods without a copay or other barriers," she said. "We know that increased access to birth control has helped bring teen pregnancy rates to a 40-year low and we must continue to drive forward policies that build on this progress."

The Kaiser study, which looked at a sample of 20 insurers in five states, found one that simply didn't cover the birth control ring (NuvaRing) at all and four more that "couldn't ascertain" coverage status. More commonly, insurers would restrict access to certain contraceptives when they believed a cheaper, equally effective way for patients to get the same treatment was available.

The report by the health law center, which analyzed coverage from 100 insurance companies during 2014 and 2015, found that 15 plans in seven states failed to cover all FDA-approved methods of birth control. Among the companies named as not complying with the law's requirements in some states are Aetna, Cigna, Physicians Plus and Anthem Blue Cross Blue Shield.

The insurance industry disputes that report's conclusion that the problem is widespread. AHIP's Ignani said at the time of its release that it presented "a distorted picture of reality."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

Free Contraceptives Must Be Free, Obama Administration Tells Insurers

Tue, 05/12/2015 - 11:06am
Free Contraceptives Must Be Free, Obama Administration Tells Insurers May 12, 201511:06 AM ET

Partner content from

Phil Galewitz

If the Food and Drug Administration has approved a type of prescription contraception, then insurers must cover at least one option at no cost to the consumer.

BSIP/Science Source

Free means free.

The Obama administration said Monday that health plans must offer at least one option for every type of prescription birth control free of charge to consumers. The instructions clarify the Affordable Care Act's contraceptive mandate.

"Today's guidance seeks to eliminate any ambiguity," the Health and Human Services Department said. "Insurers must cover without cost-sharing at least one form of contraception in each of the methods that the Food and Drug Administration has identified ... including the ring, the patch and intrauterine devices."

The ruling comes after reports by the Kaiser Family Foundation and the National Women's Law Center, an advocacy group, found many insurers were not providing no-cost birth control for all prescription methods. (KHN is an editorially independent project of the Kaiser Family Foundation.)

Gretchen Borchelt, a vice president with the women's law center, applauded the guidance. "Insurance companies have been breaking the law, and today, the Obama administration underscored that it will not tolerate these violations," she said. "It is now absolutely clear that 'all' means 'all'— 'all' unique birth control methods for women must be covered."

The law requires that preventive services, such as contraception and well-woman visits, be covered without out-of-pocket expenses, such as a copay or deductible.

While HHS said insurers must offer free at least one version of all 18 FDA approved contraceptives, the plans may still charge fees to encourage individuals to use a particular brand or generic. For example, a generic form might be free, while a brand-name version of the drug can include cost sharing, HHS said.

The administration Monday said insurers could have misinterpreted prior rules to mean they only had to offer certain types of contraception without cost-sharing. Plans have until July to implement the policy, which won't generally take effect until a new plan year begins, which is January for most people.

Karen Ignagni, CEO of trade group America's Health Insurance Plans, said she was pleased the guidance allows insurers to practice "medical management." In other works, insurers can charge a copay or deductible for some birth control rather than have to provide all brands free.

Cecile Richards, president of Planned Parenthood Action Fund, the political arm of Planned Parenthood of America, praised the move. "This is a victory for women and the more than 30,000 Planned Parenthood supporters who spoke out to ensure all women, no matter what insurance they have, can access the full range of birth control methods without a copay or other barriers," she said. "We know that increased access to birth control has helped bring teen pregnancy rates to a 40-year low and we must continue to drive forward policies that build on this progress."

The Kaiser study, which looked at a sample of 20 insurers in five states — found one that simply didn't cover the birth control ring (NuvaRing) at all and four more that "couldn't ascertain" coverage status. More commonly, insurers would restrict access to certain contraceptives when they believed a cheaper, equally effective way for patients to get the same treatment was available.

The report by the health law center, which analyzed coverage from 100 insurance companies during 2014 and 2015, found that 15 plans in seven states failed to cover all FDA-approved methods of birth control. Among the companies named as not complying with the law's requirements in some states are Aetna, Cigna, Physicians Plus and Anthem Blue Cross Blue Shield.

The insurance industry disputes that report's conclusion that the problem is widespread. AHIP's Ignani said at the time of its release that it presented "a distorted picture of reality."

Copyright 2015 Kaiser Health News. To see more, visit http://www.kaiserhealthnews.org/.
Categories: NPR Blogs

State Legislatures Quarrel Over Whether To Expand Medicaid

Tue, 05/12/2015 - 3:43am
State Legislatures Quarrel Over Whether To Expand Medicaid May 12, 2015 3:43 AM ET Annie Feidt, Alaska Public Media Eric Whitney, Montana Public Radio Listen to the Story 4:24
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Alaskans attend a rally in Anchorage for Medicaid expansion.

Jonathan Casurella/Alaska Public Media

Five years after the Affordable Care Act passed, the law's provision allowing the expansion of Medicaid coverage to more people is still causing huge fights in state legislatures.

Twenty-four states and the District of Columbia said yes to Medicaid expansion when the law went into effect. Since then, just six more have signed on. States that say yes get billions of additional federal dollars, but many Republican lawmakers are loathe to say yes to the Obama administration.

The expansion enables adults with incomes up to 138% of the poverty level to receive Medicaid. The federal government picks up the whole tab for their care through 2016, then tapers its support down to 90% of the costs.

Shots - Health News Medicaid's Western Push Hits Montana Politics Red States Move To Expand Medicaid Under Obamacare

The fight's come to Florida and also out west, where four Republican-majority states took up Medicaid expansion this year. Wyoming said no. Alaska and Utah are still wrestling. Montana said yes.

Montana lawmakers have been stewing over Medicaid expansion since they said no to it in 2013, the last time they met. When they reconvened in January, Americans for Prosperity, a group backed by David and Charles Koch, staffed up in the state and targeted moderate Republicans, organizing anti-expansion town hall meetings in their districts.

But AFP didn't invite targeted lawmakers themselves, leading to a backlash. Many voters saw AFP's tactics as meddling by outsiders, and some AFP meetings were disrupted.

Lawmakers affiliated with the Tea Party in the Montana House fought hard against Medicaid expansion. They killed a proposal by Democrats, and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to even bring the bill to the floor for a vote. But in the end, 20 Republicans crossed party lines and voted with all the Democrats to pass it.

Still, at the bill's signing ceremony, state Sen. Ed Buttrey, a Republican who sponsored the bill, said, "This is not Medicaid expansion."

Buttrey says Republicans won important concessions from Democrats to make Montana's bill more palatable to conservatives. People will have to pay small premiums, and the bill also sets up job training and education programs. Buttrey insisted that Montana isn't just doing the bidding of the White House.

"I'll say it again, and I hope the media will report this exciting and unique story," he said. "This is not Medicaid expansion."

Shots - Health News Alaska's Governor Eager To Expand Medicaid

Montana's approach is now on its way to the federal government, which will have the last word on whether it's legal under the Affordable Care Act.

In Alaska, Gov. Bill Walker, a former Republican who is now independent, has made Medicaid expansion a top priority.

But Republicans leading Alaska's state House and Senate blocked expansion during the legislative session that just wrapped up.

One of them was state Sen. Pete Kelly. "I think everyone agrees that Medicaid is broken," he says. "To put more money into it, to bring more people into it, that's certainly not going to help its brokenness."

But 65 percent of Alaskans favor Medicaid expansion. Supporters testified in large numbers at legislative committee hearings and attended rallies. In one, organized by an interfaith church group, Lutheran pastor Julia Seymour turned the crowd into a choir. She led them in singing, "Medicaid expansion, I'm going to let it shine" to the tune of This Little Light Of Mine.

Even though the measure didn't pass this session, Seymour says she's more determined than ever to make sure all Alaskans have access to health insurance.

"The Bible tells us that faith, hope and love go on and do not end. And I'm keeping the faith and I am hopeful, but my love for some of the leaders is waning now and then," she says.

As soon as the regular session ended, Gov. Walker called lawmakers into special session but legislative leaders decided to take a recess.

The state is currently facing a massive budget deficit because of the plunge in oil prices. And Walker says even in better financial times, Alaska doesn't usually decline more than a billion federal dollars.

"If that was a road project or if that was some infrastructure project, we would be all over that," he says. "This is health care."

Walker has proposed expanding Medicaid on his own if lawmakers don't act, but it's not clear he has the authority. About 40,000 people would qualify for Medicaid if the state expands it and about 30 percent of this group are Alaska Native.

This story is part of a partnership with NPR, Montana Public Radio, Alaska Public Media and Kaiser Health News.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

State Legislatures Quarrel Over Whether To Expand Medicaid

Tue, 05/12/2015 - 3:43am
State Legislatures Quarrel Over Whether To Expand Medicaid May 12, 2015 3:43 AM ET Listen to the Story 4:24
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  • Download
  • Embed Embed Close embed modal <iframe src="http://www.npr.org/player/embed/405820188/406105653" width="100%" height="290" frameborder="0" scrolling="no"> ">
  • Transcript

Alaskans attend a rally in Anchorage for Medicaid expansion.

Jonathan Casurella/Alaska Public Media

Five years after the Affordable Care Act passed, the law's provision allowing the expansion of Medicaid coverage to more people is still causing huge fights in state legislatures.

Twenty-four states and the District of Columbia said yes to Medicaid expansion when the law went into effect. Since then, just six more have signed on. States that say yes get billions of additional federal dollars, but many Republican lawmakers are loathe to say yes to the Obama administration.

The expansion enables adults with incomes up to 138% of the poverty level to receive Medicaid. The federal government picks up the whole tab for their care through 2016, then tapers its support down to 90% of the costs.

Shots - Health News Medicaid's Western Push Hits Montana Politics Red States Move To Expand Medicaid Under Obamacare

The fight's come to Florida and also out west, where four Republican-majority states took up Medicaid expansion this year. Wyoming said no. Alaska and Utah are still wrestling. Montana said yes.

Montana lawmakers have been stewing over Medicaid expansion since they said no to it in 2013, the last time they met. When they reconvened in January, Americans for Prosperity, a group backed by David and Charles Koch, staffed up in the state and targeted moderate Republicans, organizing anti-expansion town hall meetings in their districts.

But AFP didn't invite targeted lawmakers themselves, leading to a backlash. Many voters saw AFP's tactics as meddling by outsiders, and some AFP meetings were disrupted.

Lawmakers affiliated with the Tea Party in the Montana House fought hard against Medicaid expansion. They killed a proposal by Democrats, and then nearly derailed a Republican-sponsored compromise. The House had to bend its rules to even bring the bill to the floor for a vote. But in the end, 20 Republicans crossed party lines and voted with all the Democrats to pass it.

Still, at the bill's signing ceremony, state Sen. Ed Buttrey, a Republican who sponsored the bill, said, "This is not Medicaid expansion."

Buttrey says Republicans won important concessions from Democrats to make Montana's bill more palatable to conservatives. People will have to pay small premiums, and the bill also sets up job training and education programs. Buttrey insisted that Montana isn't just doing the bidding of the White House.

"I'll say it again, and I hope the media will report this exciting and unique story," he said. "This is not Medicaid expansion."

Shots - Health News Alaska's Governor Eager To Expand Medicaid

Montana's approach is now on its way to the federal government, which will have the last word on whether it's legal under the Affordable Care Act.

In Alaska, Gov. Bill Walker, a former Republican who is now independent, has made Medicaid expansion a top priority.

But Republicans leading Alaska's state House and Senate blocked expansion during the legislative session that just wrapped up.

One of them was state Sen. Pete Kelly. "I think everyone agrees that Medicaid is broken," he says. "To put more money into it, to bring more people into it, that's certainly not going to help its brokenness."

But 65 percent of Alaskans favor Medicaid expansion. Supporters testified in large numbers at legislative committee hearings and attended rallies. In one, organized by an interfaith church group, Lutheran pastor Julia Seymour turned the crowd into a choir. She led them in singing, "Medicaid expansion, I'm going to let it shine" to the tune of This Little Light Of Mine.

Even though the measure didn't pass this session, Seymour says she's more determined than ever to make sure all Alaskans have access to health insurance.

"The Bible tells us that faith, hope and love go on and do not end. And I'm keeping the faith and I am hopeful, but my love for some of the leaders is waning now and then," she says.

As soon as the regular session ended, Gov. Walker called lawmakers into special session but legislative leaders decided to take a recess.

The state is currently facing a massive budget deficit because of the plunge in oil prices. And Walker says even in better financial times, Alaska doesn't usually decline more than a billion federal dollars.

"If that was a road project or if that was some infrastructure project, we would be all over that," he says. "This is health care."

Walker has proposed expanding Medicaid on his own if lawmakers don't act, but it's not clear he has the authority. About 40,000 people would qualify for Medicaid if the state expands it and about 30 percent of this group are Alaska Native.

This story is part of a partnership with NPR, Montana Public Radio, Alaska Public Media and Kaiser Health News.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Family Doctors Who Do More, Save More

Mon, 05/11/2015 - 5:04pm
Family Doctors Who Do More, Save More May 11, 2015 5:04 PM ET

Is a good family doctor one who treats your knee pain and manages your recovery from heart surgery? Or is it one who refers you to an orthopedist and a cardiologist?

Those are questions at the heart of a debate about primary care – one with serious health and financial implications.

A study from the American Academy of Family Physician's Robert Graham Centersheds some light on this topic. The findings, published in the latest issue of Annals of Family Medicine, suggest that family doctors who provide more care themselves save the health system money.

The researchers looked at 3,652 family physicians and 555,165 Medicare patients across the country. They found that patients of physicians who provided a wider range of services experienced fewer hospitalizations and incurred lower health care costs.

"Patients were 35 percent less likely to end up in a hospital if their family doctor was very comprehensive, compared with a doctor who was minimally comprehensive," says Dr. Robert Phillips, of the American Board of Family Medicine and one of the authors of the study.

The researchers also found that doctors who performed a wider range of services reduced overall patient costs by between 10 and 15 percent.

"That is a huge bending of the cost curve," says Dr. Kevin Grumbach, chair of family and community medicine at the University of California, San Francisco, who wrote an accompanying commentary. "This probably trumps any other innovation in terms of reducing Medicare costs."

Medicare costs and overall health care costs have been rising rapidly in the U.S. for decades, consistently outpacing economic growth. Part of the reason, Phillips says, is the increased use of specialists. Roughly 80 percent of all physicians in the U.S. are now specialists, according to the American Academy of Family Physicians. That's up from 70 percent 15 years ago, and is far higher than most European countries.

Grumbach says the new study confirms a belief that had long been suspected, but has rarely been proven: Coordinated care, led by a family doctor who is judicious about referring patients to specialists, leads to cost savings.

"It goes from a matter of philosophical preference to actually showing that this saves money," Grumbach says.

Grumbach notes that the study doesn't address one important concern: quality of care. The researchers weren't able to track patient outcomes or collect data on patient experiences. So it's possible that the care received from primary care doctors was inferior, and that the cost savings weren't worth it.

"But it's also possible that the opposite is true, that these patients received better care," Phillips says. He notes that several recent studies have shown a link between more hands-on primary care and better patient outcomes.

Grumbach says future research should aim to determine where money is saved. Which primary care interventions are saving money without compromising quality? He says this will become especially important as the Affordable Care Act puts more pressure on doctors and hospitals to improve quality and reduce costs.

But for now, Grumbach says, the message of this study is clear: "Pay for quality primary care because that is the most efficient," he says. "It's not that complicated."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Family Doctors Who Do More, Save More

Mon, 05/11/2015 - 5:04pm
Family Doctors Who Do More, Save More May 11, 2015 5:04 PM ET

Is a good family doctor one who treats your knee pain and manages your recovery from heart surgery? Or is it one who refers you to an orthopedist and a cardiologist?

Those are questions at the heart of a debate about primary care – one with serious health and financial implications.

A study from the American Academy of Family Physician's Robert Graham Centersheds some light on this topic. The findings, published in the latest issue of Annals of Family Medicine, suggest that family doctors who provide more care themselves save the health system money.

The researchers looked at 3,652 family physicians and 555,165 Medicare patients across the country. They found that patients of physicians who provided a wider range of services experienced fewer hospitalizations and incurred lower health care costs.

"Patients were 35 percent less likely to end up in a hospital if their family doctor was very comprehensive, compared with a doctor who was minimally comprehensive," says Dr. Robert Phillips, of the American Board of Family Medicine and one of the authors of the study.

The researchers also found that doctors who performed a wider range of services reduced overall patient costs by between 10 and 15 percent.

"That is a huge bending of the cost curve," says Dr. Kevin Grumbach, chair of family and community medicine at the University of California, San Francisco, who wrote an accompanying commentary. "This probably trumps any other innovation in terms of reducing Medicare costs."

Medicare costs and overall health care costs have been rising rapidly in the U.S. for decades, consistently outpacing economic growth. Part of the reason, Phillips says, is the increased use of specialists. Roughly 80 percent of all physicians in the U.S. are now specialists, according to the American Association of Family Physicians. That's up from 70 percent 15 years ago, and is far higher than most European countries.

Grumbach says the new study confirms a belief that had long been suspected, but has rarely been proven: Coordinated care, led by a family doctor who is judicious about referring patients to specialists, leads to cost savings.

"It goes from a matter of philosophical preference to actually showing that this saves money," Grumbach says.

Grumbach notes that the study doesn't address one important concern: quality of care. The researchers weren't able to track patient outcomes or collect data on patient experiences. So it's possible that the care received from primary care doctors was inferior, and that the cost savings weren't worth it.

"But it's also possible that the opposite is true, that these patients received better care," Phillips says. He notes that several recent studies have shown a link between more hands-on primary care and better patient outcomes.

Grumbach says future research should aim to determine where money is saved. Which primary care interventions are saving money without compromising quality? He says this will become especially important as the Affordable Care Act puts more pressure on doctors and hospitals to improve quality and reduce costs.

But for now, Grumbach says, the message of this study is clear: "Pay for quality primary care because that is the most efficient," he says. "It's not that complicated."

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs

Tales From 3 Louisianans Who Got Subsidized Health Insurance

Mon, 05/11/2015 - 4:42pm
Tales From 3 Louisianans Who Got Subsidized Health Insurance May 11, 2015 4:42 PM ET

from

Jeff Cohen Listen to the Story 4:12
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Sheron Bazille pays $219.01 a month for her health insurance. She knows the amount down to the penny.

Jeff Cohen/WNPR

The politics of the Affordable Care Act in the state of Louisiana aren't subtle: The law isn't popular.

Shots - Health News What's At Stake If Supreme Court Eliminates Your Obamacare Subsidy

The state was part of the lawsuit to strike down Obamacare in 2012; it didn't expand Medicaid and has no plans to. Louisiana also didn't set up its own marketplace to sell health insurance.

Nevertheless, more than 186,000 people in Louisiana signed up for health coverage under the law and almost all of them got help from the federal government to pay their premiums.

Health Low, Middle Income Workers Most Vulnerable To Loss Of Obamacare Subsidies

The U.S. Supreme Court could soon rule illegal the insurance subsidies in Louisiana and more than 30 other states that use the federal website HealthCare.gov.

If the subsidies are eliminated, the number of uninsured people in the affected states would rise by 8.2 million in 2016, according to recent Senate testimony by Linda Blumberg, a senior fellow at the Urban Institute. In a Monday interview with All Things Considered's Audie Cornish, Blumberg said, "the reality is, is that the folks in states that are likely to be affected are the ones that needed the most assistance."

Jeff Cohen from member station WNPR spent three days driving around his home state of Louisiana talking with people who bought subsidized insurance under the law. Here are three of their stories.

Sheron Bazille

Law Round 2: Health Care Law Faces The Supreme Court Again

Sitting at her kitchen table in the Baton Rouge home she owns by herself, Sheron Bazille says she had a good job that offered benefits, including health insurance. But she got sick and had to stop working. "It was either me or my job," she says. "And my life and my health was more important,"

Bazille, 62, retired early, and she says leaving that job of 10 years meant losing her insurance — and some of her dignity, too. Now, under Obamacare, she's got subsidized insurance. She knows exactly how much her share is: "My monthly is $219. And one cent."

The coverage has given her a sense of security, because she can take care of her health and her health care bills.

Jimmy See had a lot of medical debt and hopes insurance means he never has to be in that position again.

Jeff Cohen/WNPR

"Peace. I have peace now that I know I have hospitalization [coverage]," says Bazille. "If anything happens, I can go to the hospital."

She worries the Supreme Court justices could take away that peace and asked what she would tell the justices if she could, she says: "Think about your kids, your family. If they could not afford to pay for health insurance. Wouldn't you want someone to help them?"

Jimmy See

At a coffee shop in Zachary, half an hour north of Bazille's home in Baton Rouge, Jimmy See says he never felt like he needed health insurance — until he did. He's 54, a self-employed housing and maintenance worker. He'd always felt like health insurance was too expensive. But then he started having trouble breathing and he went to the hospital.

"They said, 'Well do you have any insurance?' " He recalls. "And I said, 'No.' "

Rather than pay a lump sum upfront, he went home and got worse. Eventually, he collapsed, went to the emergency room and had to be hospitalized for close to two weeks for pneumonia. His remembers his bill being between $8,000 and $9,000. See negotiated with the hospital and received financial assistance.

"If I hadn't gotten that, I'd be looking for bill collectors after me," See says. "And bill collectors don't play. They come after you."

See's Obamacare subsidy covers all of his premium. He says having insurance is a relief.

James Marks pays about $180 a month for his insurance and is happy he doesn't have to depend on his parents for help with medical costs.

Jeff Cohen/WNPR

"If I had a big operation or whatever, you can't afford no $70,000, $80,000, $90,000," he says. "So, through the Affordable Care Act, the government's going to help you out with all that."

If the Supreme Court rules against subsidies, See says for him it would be, "Back to square one. No insurance."

James Marks

James Marks doesn't want to go back to square one, either.

Marks is 36 and lives four hours north of Baton Rouge in Shreveport. He works as a freelance computer technician and an after-school art teacher. Neither job provides insurance and being uninsured was a blow to his self-esteem.

"It made me feel lousy," Marks says. "It made me feel like I was sponging off my parents. It made me feel like I wasn't able to take care of myself."

Marks lives with a mental health issue. For the better part of 10 years, he says his parents paid for both his psychiatrist and his expensive medications. Now, he pays about $180 a month for a subsidized insurance policy and it makes him feel like an adult.

Asked what he would tell the justices, Marks says, "I know the Supreme Court tries to decide stuff based on the law and not based on the impact that it has on America. But it'll wind up making a lot of people who were insured, who had insurance, who were able to go to the doctor and pay for their pills, not be able to anymore. And that's just pretty lousy."

This story is part of a reporting partnership with NPR, WNPR and Kaiser Health News.

Copyright 2015 Connecticut Public Radio. To see more, visit http://www.wnpr.org.
Categories: NPR Blogs

Tales From 3 Louisianans Who Got Subsidized Health Insurance

Mon, 05/11/2015 - 4:42pm
Tales From 3 Louisianans Who Got Subsidized Health Insurance May 11, 2015 4:42 PM ET

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Jeff Cohen Listen to the Story 4:12
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Sheron Bazille pays $219.01 a month for her health insurance. She knows the amount down to the penny.

Jeff Cohen/WNPR

The politics of the Affordable Care Act in the state of Louisiana aren't subtle: The law isn't popular.

Shots - Health News What's At Stake If Supreme Court Eliminates Your Obamacare Subsidy

The state was part of the lawsuit to strike down Obamacare in 2012; it didn't expand Medicaid and has no plans to. Louisiana also didn't set up its own marketplace to sell health insurance.

Nevertheless, more than 186,000 people in Louisiana signed up for health coverage under the law and almost all of them got help from the federal government to pay their premiums.

Health Low, Middle Income Workers Most Vulnerable To Loss Of Obamacare Subsidies

The U.S. Supreme Court could soon rule illegal the insurance subsidies in Louisiana and more than 30 other states that use the federal website HealthCare.gov.

If the subsidies are eliminated, the number of uninsured people in the affected states would rise by 8.2 million in 2016, according to recent Senate testimony by Linda Blumberg, a senior fellow at the Urban Institute. In a Monday interview with All Things Considered's Audie Cornish, Blumberg said, "the reality is, is that the folks in states that are likely to be affected are the ones that needed the most assistance."

Jeff Cohen from member station WNPR spent three days driving around his home state of Louisiana talking with people who bought subsidized insurance under the law. Here are three of their stories.

Sheron Bazille

Law Round 2: Health Care Law Faces The Supreme Court Again

Sitting at her kitchen table in the Baton Rouge home she owns by herself, Sheron Bazille says she had a good job that offered benefits, including health insurance. But she got sick and had to stop working. "It was either me or my job," she says. "And my life and my health was more important,"

Bazille, 62, retired early, and she says leaving that job of 10 years meant losing her insurance — and some of her dignity, too. Now, under Obamacare, she's got subsidized insurance. She knows exactly how much her share is: "My monthly is $219. And one cent."

The coverage has given her a sense of security, because she can take care of her health and her health care bills.

Jimmy See had a lot of medical debt and hopes insurance means he never has to be in that position again.

Jeff Cohen/WNPR

"Peace. I have peace now that I know I have hospitalization [coverage]," says Bazille. "If anything happens, I can go to the hospital."

She worries the Supreme Court justices could take away that peace and asked what she would tell the justices if she could, she says: "Think about your kids, your family. If they could not afford to pay for health insurance. Wouldn't you want someone to help them?"

Jimmy See

At a coffee shop in Zachary, half an hour north of Bazille's home in Baton Rouge, Jimmy See says he never felt like he needed health insurance — until he did. He's 54, a self-employed housing and maintenance worker. He'd always felt like health insurance was too expensive. But then he started having trouble breathing and he went to the hospital.

"They said, 'Well do you have any insurance?' " He recalls. "And I said, 'No.' "

Rather than pay a lump sum upfront, he went home and got worse. Eventually, he collapsed, went to the emergency room and had to be hospitalized for close to two weeks for pneumonia. His remembers his bill being between $8,000 and $9,000. See negotiated with the hospital and received financial assistance.

"If I hadn't gotten that, I'd be looking for bill collectors after me," See says. "And bill collectors don't play. They come after you."

See's Obamacare subsidy covers all of his premium. He says having insurance is a relief.

James Marks pays about $180 a month for his insurance and is happy he doesn't have to depend on his parents for help with medical costs.

Jeff Cohen/WNPR

"If I had a big operation or whatever, you can't afford no $70,000, $80,000, $90,000," he says. "So, through the Affordable Care Act, the government's going to help you out with all that."

If the Supreme Court rules against subsidies, See says for him it would be, "Back to square one. No insurance."

James Marks

James Marks doesn't want to go back to square one, either.

Marks is 36 and lives four hours north of Baton Rouge in Shreveport. He works as a freelance computer technician and an after-school art teacher. Neither job provides insurance and being uninsured was a blow to his self-esteem.

"It made me feel lousy," Marks says. "It made me feel like I was sponging off my parents. It made me feel like I wasn't able to take care of myself."

Marks lives with a mental health issue. For the better part of 10 years, he says his parents paid for both his psychiatrist and his expensive medications. Now, he pays about $180 a month for a subsidized insurance policy and it makes him feel like an adult.

Asked what he would tell the justices, Marks says, "I know the Supreme Court tries to decide stuff based on the law and not based on the impact that it has on America. But it'll wind up making a lot of people who were insured, who had insurance, who were able to go to the doctor and pay for their pills, not be able to anymore. And that's just pretty lousy."

This story is part of a reporting partnership with NPR, WNPR and Kaiser Health News.

Copyright 2015 Connecticut Public Radio. To see more, visit http://www.wnpr.org.
Categories: NPR Blogs

Concussions Can Be More Likely In Practices Than In Games

Mon, 05/11/2015 - 9:48am
Concussions Can Be More Likely In Practices Than In Games May 11, 2015 9:48 AM ET Listen to the Story 2:09
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Parents worry about a child getting a concussion in the heat of competition, but they also need to be thinking about what happens during practices, a study finds.

High school and college football players are more likely to suffer a concussion during practices than in a game, according a study published May 4 in JAMA Pediatrics. Here are the numbers:

  • In youth games, 54 percent of concussions happened during games.
  • In high school and college, just 42 percent of concussions happened during games, with 58 percent during practices.
  • Overall, college students had the highest rate of concussions during games, with 3.74 per 1,000 games compared to 2.01 for high schoolers and 2.38 for youths. High schoolers had the highest rates during practices.
Shots - Health News High Schools Seek A Safer Path Back From Concussion

The numbers are gleaned from three large injury surveillance systems that evaluated the 2012 and 2013 seasons of 118 youth football teams, 96 high school programs and 24 college programs. They were gathered by the Datalys Center for Sports Injury Research and Prevention Inc., in Indianapolis. They don't reflect the number of concussions, but rather players who reported having at least one concussion during the season.

Shots - Health News Football Players Drill Without Helmets To Curb Concussions

"The number of people exposed during practice is always higher than in games," says Tom Dompier, president of Datalys and lead author of the study, "because not all kids at the high school and college level will play in games." Players at that level log many more hours of practice time than do younger athletes.

Although it may be hard to change the intensity of a game, the authors note, "many strategies can be used during practice to limit player-to-player contact and other potentially injurious behaviors."

Some experiments are already underway. At the University of New Hampshire, half the squad practices without helmets. The school is monitoring players to see if that changes the number and force of hits.

Shots - Health News Sideline Robot Helps Trainers Spot Football Concussions

Chris Merritt, the head football coach at Christopher Columbus High School in Miami, has helped pilot USA Football's Heads Up program, which teaches blocking and tackling techniques that keep the head out of the way.

"You can't just sit there and line up four days a week and go full-go and tackle, bring to the ground," Merritt says. "There are too many opportunities that someone is going to hit helmet on helmet or helmet on the ground."

Football is the most popular sport in the nation for high school boys, according to the National Federation of State High School Associations, with 1.1 million boys playing. Track and field is a distant second, with 580,000 athletes.

Since boys start learning tackle football as young as age 5, it's vital that youth coaches teach safer techniques, Merritt says. Getting the message out can be tough, he says, because "they're not professionals for the most part; they're volunteers."

The NCAA was one of the funders of the study, along with USA Football and the National Athletic Trainers Association Research and Education Foundation.

An earlier version of this story ran in Shots on May 4. This version includes interviews from the May 11 Morning Edition story.

Copyright 2015 NPR. To see more, visit http://www.npr.org/.
Categories: NPR Blogs