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My first big project at The Courier-Journal was to investigate why Kentucky ranks among the worst in the nation on almost every indicator of health — cancer deaths, smoking, obesity, diabetes, heart disease and many others.
The project included several county-by-county maps, which showed health outcomes were almost always worst in Eastern Kentucky, the poorest region of the state. A map showing poverty rates by county looked eerily similar.
Yesterday, I spoke at the Kentucky Public Health Association’s 2014 annual conference, and one of the attendees handed me some maps developed by Hayslett Group LLC in connection with a presentation to public health administrators across the state. One map shows 2013 economic rankings, calculated based on a formula used by Georgia that averages county rankings for unemployment rates, poverty rates and per-person income. Another map shows health rankings from the Robert Wood Johnson Foundation’s 2013 County Health Rankings and Roadmaps Report.
These maps show things haven’t changed much since those 2005 stories. And that’s not too surprising, according to many health care experts I’ve interviewed over the years. They say health is inextricably linked to wealth and poverty.
Here’s the top of the first story in my 2005 series, “Kentucky’s Health: Critical Condition”:
Kentucky is one of the sickest states in America, a place where too many people die too soon, and many who live endure decades of illness and pain.
Its residents as a whole fare poorly on almost every health measure – second worst in the nation for cancer deaths , fifth worst for cardiovascular deaths, seventh worst for obesity. Kentucky adults smoke at the highest rate in the nation and exercise at the lowest.
And Kentuckians die at a rate 18 percent above the national average.
Kentucky’s poor health threatens the lives of residents, the productivity of the population and the economy of the state – while hitting every resident in the pocketbook through taxes and insurance premiums.
The ravages of disease can be found off mountain roads, rural byways and city streets in every corner of the state.
Deep in the Eastern Kentucky hills of Hindman, in a ramshackle house surrounded by a graveyard of junk cars, 68-year-old Betty Holland stretches back on her bed. Weakened by a heart attack, she is tethered to an oxygen machine to help her breathe and has bruises on her arms from dialysis for failed kidneys. She is completely dependent on her husband and spends her days watching television in the cluttered chaos of their living room.
At the Nu-U Beauty Salon in Marion in Western Kentucky, hairdresser Sharon Riley combs and snips as she recalls her husband’s heart attack and her mother’s fight with cervical cancer. Jerilyn May, getting her gray hair cut and styled, speaks of losing a breast to cancer.
In Louisville, Josephine Wright says a part of her is gone after lung cancer took her husband of 30 years.
At the White House Clinic in McKee in Eastern Kentucky, Dr. Sandra Dionisio, an internist trained in the Philippines, remembers a patient with cancer so advanced she had a foul-smelling, open wound in her breast.
“I see a lot of illnesses similar to a third-world country,” Dionisio says.
The factors behind Kentucky’s health crisis, a Courier-Journal investigation has found, collide like a perfect storm.
Poverty is at the center , tied to everything from nutrition to health habits to the medical care people receive. Kentucky has 43 of the nation’s 340 persistently poor rural counties. Only Mississippi, which ranks neck and neck with Kentucky on an index of health measures, has more.
The same dynamics were clear in a report released last week by the Center for Health Equity, a division of the Louisville Metro Department of Public Health and Wellness. The report looked at health statistics by neighborhood and by race.
One of the most striking findings involved life expectancy, which differs by more than 11 years depending on where residents live in Louisville. The shortest life span — 70.8 — was in the Downtown-Old Louisville-University area. The longest — 82.1 — was in St. Matthews.
“Poverty is one of the strongest social determinants of health,” researchers wrote in the recent report. “An individual living in poverty is greatly limited in terms of access to affordable healthy food, safe environments, healthcare, education and man other factors. Adults living in poverty are more than five times as likely to report that they are in poor or fair health.”
WASHINGTON — President Obama said Thursday that a total of 8 million people signed up for health insurance under the Affordable Care Act during the initial enrollment period that ended March 31.
“The Affordable Care Act is now covering more people at less cost than most would have predicted just a few months ago,” Obama said during a White House news conference.
The rise in health care costs is slowing and previously uninsured Americans are now covered, Obama said, adding: “This thing is working.”
Obama again criticized Republicans who want to repeal the law, saying it’s time to “move on” and focus on jobs and the overall economy. He called for “a change in attitude on the part of the Republicans.”
Congressional Republicans continued to criticize the law, questioning the significance of some of the statistics and saying it will lead to higher costs and worse health care for most Americans.
“I have a question,” tweeted House Majority Leader Eric Cantor, R-Va. “How many Obamacare enrollees were previously uninsured?”
Senate Minority Leader Mitch McConnell, R-Ky., cited the number of people who saw previous policies canceled: “Noticeably absent from the president’s remarks today was any mention of the millions of Americans who were deceived about what Obamacare would mean for them and their families.”
Opponents of the law say they’re still waiting to hear how many people pay for their policies, if enough healthy people have enrolled to make the exchanges financially workable in the future and how many of the enrollees use a month’s worth of benefits to cover medical procedures they couldn’t afford before but then discontinue paying for their insurance.
Obama spoke shortly after meeting with a group of state insurance commissioners, some of whom reported that the president cited a rush of young people — under age 35 — signing up late.
In the state-based insurance exchanges, 28% of new enrollees were ages 18 to 34, the Department of Health and Human Services reported Thursday. The department also touted the 3 million adults younger than 26 who are insured through their parents’ plans, and 3 million people enrolled in Medicaid and the Children’s Health Insurance Plan program as of February.
The news follows a busy week on the health care front.
Health and Human Services Secretary Kathleen Sebelius announced last Thursday she would step down from her post, the same day she told the House Finance Committee that the exchanges had enrolled at least 7.5 million people — 1.5 million more than the Congressional Budget Office projected in February, and half a million more than the office originally projected last year.
Obama has nominated Sylvia Mathews Burwell, current director of the Office of Management and Budget, to replace Sebelius at HHS.
On Monday, CBO reported that it expects as many as 5 million people a year to get health insurance directly through private insurers. That’s in addition to the 8 million Obama said have now signed up through the ACA exchanges.
There’s been much written in the past year about just how hard it is to get a simple price for a basic health-care procedure. The industry has heard the rumblings, and now it’s responding.
About two dozen industry stakeholders, including main lobbying groups for hospitals and health insurers, this morning are issuing new recommendations for how they can provide the cost of health-care services to patients.
The focus on health-care price transparency — discussed in Steven Brill’s 26,000-word opus on medical bills for Time last year — has intensified, not surprisingly, as people are picking up more of the tab for their health care. Employers are shifting more costs onto their workers, and many new health plans under Obamacare feature high out-of-pocket costs.
The health care-industry has some serious catching up to do on the transparency front. States have passed their own health price transparency laws, Medicare has started to dump raw data on the cost of services and what doctors get paid, and private firms have developed their own transparency tools.
“We need to own this as an industry. We need to step up,” said Joseph Fifer, president and CEO of the Healthcare Financial Management Association, who coordinated the group issuing the report this morning. The stakeholder group includes hospitals, consumer advocates, doctors and health systems.
Their recommendations delineate who in the health-care system should be responsible for providing pricing information and what kind of information to provide depending on a person’s insurance status. Just getting the different stakeholders on the same page was difficult enough in the past, said Rich Umbdenstock, president and CEO of the American Hospital Association.
“We couldn’t agree on whose role was what. We were using terms differently,” he said.
The report’s major recommendations include how to provide patients with:
“I think that the focus now, unlike three years ago when it was on access, the focus is about affordability,” said Karen Ignagni, president and CEO of America’s Health Insurance Plans. “What are the prices being charged? It leads consumers to want to know, ‘How do I evaluate all that?’”
To give a sense of just how murky health pricing can be, one of the group’s recommendations is for providers to offer uninsured patients their estimated cost for a standard procedure and to make clear how complications could increase the price. You would think that shouldn’t be too hard — there’s no insurer to deal with, no contracts to consult.
But previous research points out just how difficult it can be to get the price for a basic, uncomplicated procedure. In a study published this past December, researchers found that just three out of 20 hospitals could say how much an uninsured person should expect to pay for a simple test measuring heartbeat rate.
The group’s recommendations also touches on limits to transparency and the “unintended consequences” of too much data being public. Care providers, employers and health plans have negotiated rates, which isn’t necessarily something they want out in the public. They warn making those negotiations publicly could actually discourage negotiations for lower prices — naturally, there are conflicting opinions on this point.
The report nods to other ways at achieving transparency. For example, it talks about “reference pricing” in self-funded employer health plans, in which employers limit what they’ll pay for an employee’s health-care services — thus setting the reference price.
“The employer communicates to employees a list of the providers who have agreed to accept the reference price (or less) for their services. If an employee chooses a provider who has not accepted the reference price, the employee is responsible for the amount the provider charges above the reference price,” the report reads, noting that Safeway grocery stores implemented a successful pilot program that expanded a few years ago.
Perhaps what’s most significant about these recommendations is the stakeholders’ acknowledgement that the health-care market is changing. Consumers are being asked to pay more, so they’re trying to become better health-care shoppers
AHIP’s Ignagni said most insurers already provide cost calculator tools and quality data on their Web sites. Providers, said the AHA’s Umbdenstock, need to be more accommodating to patients’ price-sensitivity.
“‘We can’t answer your question’ may have worked in the past, but it doesn’t fly any longer,” said Mark Rukavina, principal with Community Health Advisors and a report contributor. “This [report] basically lays out the principles for creating a new response to the question.”
hide captionXanax and Valium, prescribed to treat anxiety, mood disorders and insomnia, can be deadly when mixed with other sedatives.
When actor Philip Seymour Hoffman died of an overdose in February, the New York City medical examiner ruled that his death was the result of “acute mixed drug intoxication.” Heroin, cocaine and a widely prescribed class of drugs known as benzodiazepines, or benzos, were found in his system.
The drugs first burst onto the scene in the 1950s and ’60s and quickly became known as “mother’s little helper,” the mild tranquilizer that could soothe frazzled housewives’ nerves. More than four decades later, benzos — including Valium, Xanax, Klonopin and Ativan — are used to treat anxiety, mood disorders and insomnia.
Dr. Michael Kelley, the medical director of the behavioral department at St. Mary’s Regional Medical Center in Lewiston, Maine, says he doesn’t go a single day without seeing somebody addicted to them.
hide captionSayra Small, with her son, Holden. Small is now in recovery after an addiction to benzodiazepines and opioid painkillers.
Courtesy of Sayra Small
Courtesy of Sayra Small
He says when he first took the job 15 years ago, about 75 percent of the detox patients were alcoholics, and the rest were drug addicts. Now, he says, 90 percent of them are drug addicts whose drugs of choice often include the combined use of opiates and benzos; both are sedatives that can slow respiration.
“It’s actually pretty rare to see somebody only using only one,” he says — and that’s incredibly dangerous.
“Benzodiazepines and the opiates both can cause death when you take too much of them,” he adds. “But they potentiate each other — they make each other stronger. And so one plus one doesn’t equal two; it equals three or four.”
Sayra Small says that in her early 20s, it was easy to find a doctor willing to prescribe benzos for her anxiety. She loved them because they worked so well. “It makes it so you have no problem,” she says. “I mean the house could burn down and you’d just sit there saying, OK, this is all right.”
The problem was, she was also addicted to prescription painkillers and heroin. And pretty soon, Small says, she was dependent on benzos, too.
“When you first start using opiates you instantly get the rush. Well, for me, I loved the rush but that wasn’t about it. It was the feeling afterwards of just feeling so content. Lots of people call it ‘the nod,’ ” she says. “And that stops happening after a while just using opiates. So, it’s the benzos and opiates together that still produce that nod. It feels very easy when you’re feeling that way, too, like you could just slip away.”
Small almost did slip away. She says she overdosed several times before getting into recovery — but she was lucky. Data from the Centers for Disease Control and Prevention show that the combination of benzos and opioids contribute to about 30 percent of opioid-related deaths.
Small ended up in the care of Dr. Mark Publicker, an addiction specialist with the Mercy Recovery Center in Westbrook, Maine. He says he thinks the risks associated with benzos have been overshadowed by the prescription opioid epidemic.
“They do produce a strong, physical dependence that can create life-threatening withdrawal seizures and other consequences, but I think that the perception that they’re harmful is low,” he says.
Small learned that the hard way. She says her detox for benzos was far more difficult than it was for the opioid painkillers she was also abusing. “I mean, I couldn’t move, I couldn’t eat. I don’t want to say anything too graphic, but anything you had came out one end or the other.
“But emotionally,” she says, “you just feel stripped. You feel naked to the world.”
Now 34, Small has been in recovery for a couple of years. She still gets anxious but says she’s learned to deal with life on her own terms, without relying on the medications she thought were her friends.
Syracuse, NY — Just two months old, the Cheesecake Factory at Destiny USA has already failed two health inspections and been the subject of four health-related complaints from customers.
Now it’s seeking to fill two top management posts: Restaurant manager and kitchen manager.
The kitchen manager oversees “all kitchen staff and staffing levels, safety and sanitation, housekeeping, and made from scratch food production related activities,” according to an ad on the company’s web site.
The restaurant manager is responsible for what the industry calls “front of the house” duties, including wait staff and “staffing levels, proper restaurant ambience, housekeeping, and set-up, food beverage quality, safety and pace,” a company ad says.
The ads say the managers are expected to “set the standards” for the staff.
The ads may or may not be related to the health inspections. Calls and emails to Cheesecake Factory’s public relations office in California have not been returned.
The Cheesecake Factory at Destiny employes about 300 people. The 12,000-square-foot restaurant is on the first level of Destiny’s expansion section, across from BCBG MaxAzria.
The restaurant passed a health inspection before it opened Feb. 11, according to Onondaga County environmental health director Kevin Zimmerman.
On Feb. 25, a customer filed a complaint after suspecting he or she became sick while eating at the restaurant. A health inspection the next day turned up several violations, including raw chicken and shrimp kept at temperatures well above the 45-degree requirement.
A follow-up inspection, on March 26, found 13 violations, including improper handling and temperature controls on raw meat, employees handling ready-to-serve food with their bare hands, and other issues of cleanliness and temperature control.
All violations that could lead to food-borne illnesses were corrected before the inspectors left, Zimmerman said, and the restaurant was not closed.
In addition, Zimmerman said, the health department received three other complaints in March: One was from someone suspecting a food-borne illness and two were from customers who said meat dishes were undercooked.
The restaurant has agreed to pay a $250 fine, and admitted to the violations, Zimmerman said. The case will not be considered closed until the health department concludes a satisfactory follow-up inspection, Zimmerman said.
hide captionMore than just hungry or wet?
George Marks/Getty Images
George Marks/Getty Images
Somewhere between bliss and exhaustion. That’s how the first few months of parenting often feel, as sleepless nights blur into semicomatose days.
Most of us chalk up a baby’s nighttime crying to one simple fact: He’s hungry.
But could that chubby bundle of joy have a devious plan?
Harvard University’s David Haig thinks so. Last month the evolutionary biologist offered up a surprising hypothesis to help explain those 2 a.m. feedings and crying jags: The baby is delaying the conception of a sibling by keeping Mom exhausted and not ovulating, Haig writes in the current issue of the journal Evolution, Medicine and Public Health.
hide captionThose lungs were made for screaming: In earliest human times, babies that cried and woke their moms at night had a better chance of surviving and having their own children.
Now, the baby isn’t consciously trying to halt Mom’s fertility, Haig explains. But if that happens, it ups the likelihood that the baby’s genes will be passed along to the next generation. In other words, the drive to wake Mom (or Dad) up is an evolutionary one: Babies that scream and suckle in the wee hours are more likely to survive and have children themselves.
“It’s clear that babies can get enough milk even if they sleep through the night,” Haig tells Shots. “The waking becomes a different issue. … I’m just suggesting that offspring have evolved to use waking up mothers and suckling more intensely to delay the birth of another sibling.”
Sounds a bit crazy, right? But there’s logic to the idea.
When times are tough — say during food shortages or when infectious diseases are common — babies and toddlers have a better chance of surviving when their parents wait a while before having another child.
Nursing a child, especially at night, seems to hinder many women from resuming ovulation soon after a pregnancy. So if a baby can force Mom to feed him at night, she may stay infertile longer. And then the baby will have Mom and Dad all to himself. And a better chance of survival.
It’s probably not that simple, though, says anthropologist Holly Dunsworth, of the University of Rhode Island. “It’s an interesting perspective,” she says, “but it’s not the only one.”
Haig’s idea doesn’t take into account all the benefits of nightly feedings, Dunsworth says. The baby gets not only nourishment but also love and warmth. And the mom benefits, as well.
“There are so many good juices running through infant and mom,” she adds. “It’s rewarding beyond the calories and hunger satiation for everyone involved. … When you look at it from that perspective, waking up to feed looks more like cooperation than conflict.”
Plus, notes Harvard evolutionary biologist Katherine Hinde, babies evolved to cry at night thousands and thousands of years ago when people’s sleeping habits weren’t like they are today.
Back then, people weren’t working 9 to 5 in offices and trying to get eight hours of sleep. Instead, we were likely hunters and gatherers whose sleep schedules were flexible and likely fragmented. “The expectation that mothers and infants ‘should’ have uninterrupted, consolidated sleep is, in many ways, a historical artifact,” Hinde writes in the same journal, in a response to Haig’s idea.
Like all evolutionary arguments, the theory that babies are intentionally tiring out Mom is nearly impossible to test, Haig admits. We can’t go back and study our hunter-gatherer ancestors.
But Haig hopes the idea might help relieve anxiety some parents feel when it comes to shaping the sleeping and nursing habits of their babies — including, perhaps, training babies to sleep through the night.
“I want parents to know that children are quite robust and can handle a variety of environments,” Haig says. “One shouldn’t be too anxious with minor variations in parental care.”
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In generations past, cocktails were recommended for nervous, expectant mothers. Advertisements suggested that cigarettes could relax mothers-to-be. And some urged pregnant women to avoid excitement, and spend most of their time in bed.
And there seems to have been little agreement about how much exercise — if any — pregnant women should get.
Now, the advice couldn’t be more different. Researchers have learned more precisely what risks pregnant women face, and what they can do to protect their health — and the health of their unborn children. New research is increasingly revealing the dimensions of pregnant women’s vulnerability, its time frame, and long-lasting consequences.
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But while there are many things expectant mothers should do, one thing they shouldn’t do is stress about what they can’t control.
“It’s not about living in fear, it’s about living life to its fullest,” said Dr. Hope A. Ricciotti, chairwoman of Obstetrics and Gynecology at Beth Israel Deaconess Medical Center.
Pregnancy is also an opportunity for the mother to pick up good habits, Ricciotti said, and to lay a strong foundation for her child’s future health.
“It’s a jumping off point for exercise and dietary changes that can then stick for life,” Ricciotti said.
Today obesity is one of the biggest pregnancy dangers, Ricciotti and others said. Two-thirds of women are now overweight or obese — putting them at higher risk for pregnancy complications.
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“This is by far our number one problem,” said Raul Artal, professor and chairman of the department of Obstetrics and Gynecology and Women’s Health at the Saint Louis University School of Medicine.
Women who are overweight or obese – particularly if they don’t get much exercise – are more likely to deliver prematurely and develop blood clots, diabetes, and heart disease later in life, among other problems. Although weight loss before pregnancy is best, moderate exercise five times a week for 30 minutes each time is enough to significantly reduce the risks during pregnancy. “You don’t have to run marathons or climb [Mount] Everest,” Artal said. “Just walking alone is beneficial.”
In recent years, it’s become clear that excess pounds and lack of exercise also affect the child, putting him or her at higher risk for obesity, diabetes, and heart disease decades later, Artal said. Some research has suggested that genes turned on or off during pregnancy can stay that way through at least one or two generations.
Other risks to mother and child during pregnancy relate to the mother’s health status, and the environment she and her baby are exposed to, researchers said.
Mothers with uncontrolled autoimmune disease – such as rheumatoid arthritis, lupus, or Crohn’s disease – are much more vulnerable to preeclampsia, a form of pregnancy-related high blood pressure, which can put both the mother and child’s life at risk, said Dr. Sarosh Rana, an assistant professor and preeclampsia expert at Harvard Medical School and Beth Israel Deaconess Medical Center. Women with preeclampsia during pregnancy have a much higher risk of developing heart disease as they age, Rana said.
Some pregnant women should consider taking a daily baby aspirin after their first trimester if they’re at increased risk of developing preeclampsia, according to a proposed recommendation issued last week by the US Preventive Services Task Force, a government-sponsored panel of prevention experts.
Other medical groups including the American College of Obstetricians and Gynecologists and the American Heart Association also recommend low-dose aspirin therapy in high-risk pregnant women. Preeclampsia affects about 5 percent of pregnant women and can result in preterm delivery, severe hypertension, stroke, and seizures — even death of the mother in rare cases.
“Only a small percentage of pregnant women are at high risk for preeclampsia,” Task Force chairman Dr. Michael L. LeFevre said in a statement. “Before taking aspirin, pregnant women should talk to their doctor or nurse to determine their risk and discuss if taking aspirin is right for them.”
When a mother is depressed during pregnancy, she might not be able to take care of herself as well as she’d like, putting the baby at some risk. But antidepressants can also pose problems, said Adam Urato, a maternal-fetal medicine physician at Tufts Medical Center and an assistant professor at the Tufts University School of Medicine. Women taking antidepressants are at increased risk of delivering prematurely, with some studies showing that as many as one-quarter to one-third of women taking antidepressants deliver prematurely, according to an analysis Urato published last month in the journal PLOS ONE.
For many women, non-drug approaches such as psychotherapy, are as good or better than medications, said Urato, who suggests that women consider tapering off their antidepressants before getting pregnant, unless they are likely to become severely depressed and unable to care for themselves and their child.
Infections are another challenge in pregnancy, affecting roughly 5 percent of women, Artal said.
Frequent hand-washing can cut down on illness, but if a pregnant mom has older children at home — going to day care or school — it’s nearly impossible to avoid all illnesses during pregnancy, said Stanley Gall, a professor of obstetrics and gynecology at the University of Louisville School of Medicine.
Gall strongly recommends that pregnant women get vaccinated before or early in their pregnancy against the flu, hepatitis A and B, pneumonia and the combination shot for diphtheria, tetanus and pertussis. All have been shown safe during pregnancy, he said, and all provide protection against diseases that could have terrible ramifications on the child.
Even the simple flu during pregnancy increases a baby’s risk four- or five-fold of developing psychiatric illnesses such as schizophrenia later in life, he said.
Pregnant women who get high fevers should always take fever-reducing medication and take care not to get dehydrated he said. Research in recent years has shown that children of women who spike a high fever in pregnancy are more likely to develop autism, among other conditions, said Irva Hertz-Picciotto, professor and chief of the division of Environmental and Occupational Health at the University of California Davis.
A study published late last month in the New England Journal of Medicine found that autism most likely begins in early pregnancy, when the child’s brain is developing. Hertz-Picciotto has shown that prenatal vitamins taken just before pregnancy, along with spacing pregnancies out by at least a year, can help reduce the likelihood that a child will develop autism.
In today’s world, it’s nearly impossible for pregnant women – or anyone else – to avoid exposure to potentially dangerous chemicals, said R. Thomas Zoeller, an endocrinologist and professor of biology at the University of Massachusetts Amherst.
There are some chemicals “for which there’s good evidence there’s a risk,” Zoeller said, so pregnant women should try to avoid them. He includes bisphenol A, a chemical found in plastics and the lining of some food cans; phlalates, often found in beauty products; and flame retardants. He recommends against putting plastic containers – particularly baby bottles – in the dishwasher or microwave, which can allow chemicals to leach out.
But pregnant women, he said, shouldn’t make themselves crazy trying to ferret out every potential danger.
“You do the best you can do, but you still need to pursue happiness,” Zoeller said. “It doesn’t advance your ability to be a good parent to be nervous about these kind of things. There are certain things we know about. You can deal with those and move on.”
Congress passed the misnamed Patient Protection and Affordable Care Act four years ago. It was a signal political achievement. Alas, ObamaCare is proving to be a policy bust as Kathleen Sebelius leaves her job as Secretary of Health and Human Services. Americans are suffering from a law that even many legislators did not understand. Secretary Sebelius desperately sought to put off the inevitable political reckoning by issuing waivers to and delaying implementation of the law’s pernicious requirements.
Nevertheless, health insurance premiums are rising dramatically, especially for the young. The federal government now mandates that policies include expensive “benefits” that many people do not need or desire. Some provisions, such as coverage for contraceptives, were added for purely political reasons. Making insurers pay for more services meant they must charge more for policies—paid for by patients left with no choice but insurance designed to satisfy government bureaucrats.
Even more dramatic is the reverse Robin Hood redistribution from the generally lower-income young to the mostly wealthier old. Health care needs and thus costs rise with age. By requiring coverage irrespective of health status and limiting risk-based premium differentials ObamaCare shifted costs from gray-haired investment bankers to newbie sales associates. Despite the administration’s faux shock at the huge premium increases for the young, the legislation is working precisely as intended.
Along with higher premiums came the destruction of existing plans. The president’s promise that if people liked their policies they could keep them was a calculated and cynical deception. After all, the legislation explicitly overrode private choice to impose Washington’s preferred “benefit” mix. On everyone. Anyone with different coverage can expect to ultimately lose his or her preferred coverage. Only those in “grandfathered” plans, which will naturally diminish over time, currently avoid the federal diktat.
In short, today politics, not medicine, determines what health insurance must cover. The government decided to punish those who selfishly sought to tailor medical coverage to meet their own and their family’s needs, rather than to serve Washington’s ends. Thus, higher premiums and fewer options were not an unintended consequence of ObamaCare. They were ObamaCare’s objective.
Another impact of the PPACA, discussed in a new report from the American Health Policy Institute, is to increase business costs. The law hikes expenses in numerous ways. Explained AHPI, ObamaCare imposed a Patient Center Outcomes Research Institute fee, Temporary Reinsurance Fee, and excise tax on high-cost plans, mandated expensive benefits, and generated administrative and implementation costs.
Moreover, companies ultimately will end up paying at least a share of new supply chain taxes (such as for medical devices), more for cost-shifting from expanded Medicaid coverage, and extra for employees newly relying on company policies to satisfy the Obama insurance mandate. Finally, premiums will receive another boost as health care costs rise due to the jump in overall demand in response to increased insurance coverage of more services for more people.
In 2012 large employers spent about $580 billion to cover 171 million employees and dependents. AHPI figured these companies would have to spend an extra $151 billion to $186 billion on health care coverage over the next decade. That’s an average of $163 million to $200 million per firm, predicted to yield an increase of 4.3 percent in 2016 and 8.4 percent in 2023. The extra cost per employee would be between $4800 and $5900. Similar results came from a 2013 survey by the International Foundation of Employee Benefit Plans, which found that the PPACA increased the average cost of health care expenses for large firms by 3.5 percent. An earlier Urban Institute study figured the average increase at 4.3 percent.
Some amount of this new expense will be shifted to customers. How much depends on consumer demand and industry competitiveness. Moreover, companies will lose revenue as higher prices reduce sales.
Firms also will more aggressively shift costs onto employees. Between 1999 and 2013 the cost of employer-provided health insurance trebled for both single and family coverage. Business responses included High Deductible Health Plans, Health Savings Accounts, Health Reimbursement Arrangements, value-based insurance plans, and increased transparency in cost and pricing.
The International Foundation of Employee Benefit Plans reported that most common way firms said they intended to respond to ObamaCare was to continue moving costs to workers, as well as undertaking value-based health care initiatives and additional wellness programs. A March survey from Mercer found businesses to be particularly concerned over the excise tax on expensive plans and increased administrative costs. Eight of ten employers had raised or were considering raising deductibles; 68 percent were looking at consumer-directed health plans and health saving accounts; 53 percent were targeting high-cost plans; 44 percent were considering unbundling dental and medical plans; and 34 percent were thinking of moving to high-performance networks.
There is nothing intrinsically wrong with any of these strategies. In fact, consumer-directed coverage expands choice, improves accountability, and reduces costs, and is a sensible approach under any circumstance. However, the government first made everyone worse off by arbitrarily increasing costs, penalizing employers and employees alike.
The third consequence of the PPACA’s cost increases is to raise the price of hiring workers, which will reduce the number of jobs. The principle is simple: the more expensive government makes it for companies to add workers, the fewer workers companies will add.
English: Barack Obama signing the Patient Protection and Affordable Care Act at the White House Español: Barack Obama firmando la Ley de Protección al Paciente y Cuidado de Salud Asequible en la Casa Blanca (Photo credit: Wikipedia)
Unfortunately, the administration is hiking business costs in more areas than just health care. Last year the Heritage Foundation’s James Gattuso and Diane Katz estimated that annual regulatory costs jumped roughly $70 billion during President Obama’s first term. Explained Gattuso and Katz: “While historical records are incomplete, that magnitude of regulation is likely unmatched by any administration in the nation’s history.” In its fourth year alone the administration issued 2605 new rules, with annual regulatory costs jumping more than $23.5 billion. On top of that was another $4.6 billion in one-time implementation costs.
The biggest offender was the Environmental Protection Administration, which accounted for more than half of the new first term regulatory costs, or $38 billion. The Department of Transportation imposed $16 billion worth. In 2012 the biggest offender was financial regulation under the Dodd-Frank legislation. Finally, even then the impact of ObamaCare was rising, with Gattuso and Katz predicting for the latter “an aggregate cost of $18 billion annually by 2016.”
Article source: http://www.forbes.com/sites/dougbandow/2014/04/14/kathleen-sebelius-leaves-government-after-wrecking-health-care-market-american-people-stuck-with-higher-costs-fewer-choices-lost-jobs/