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Abington Health, Jefferson merger plan advances

Abington Health in Montgomery County and Center City’s Jefferson Health System have taken a step closer to a merger by signing a letter of intent to work toward a final agreement, the two organizations said Wednesday.

The proposed deal, which could be completed next year, comes just months after Jefferson split amicably from its former longtime partner, the highly profitable Main Line Health system.

Stephen Klasko, Jefferson’s president and chief executive, said the structure of the proposed merger with Abington would allow him to achieve something that was not possible with Main Line Health.

“The real issue is to create a nimble, flexible, totally strategically aligned clinical and economic unit,” Klasko said. “For lots of reasons with Main Line Health, that wasn’t going to happen.”

The proposal includes an unusual governance structure for two organizations of such disparate sizes. Jefferson, which now includes Thomas Jefferson University and the affiliated hospitals, has $2.3 billion in annual revenue, according to Klasko.

Abington’s revenue in the year ended June 30 was $774 million, according to its financial statement.

Despite that difference in size, the two organizations will have equal representation on the board that will oversee the combined operations. The plan is to include two to four additional board members from outside the two nonprofits.

Klasko said the idea of equal representation on the board came from Jefferson and was not negotiated by Abington.

“This shared governance is not a gimmick,” said Klasko, who will be president and CEO of the combined entity. “What it allows us to do is literally start from scratch with a board that is not thinking of themselves as Jefferson and Abington.”

The new board will have fewer than 20 members, said Laurence Merlis, Abington’s president and CEO, whose role in the new organization has not yet been determined.

“We want a very small guiding group,” said Merlis, who is making his second attempt to find a merger partner for Abington. A plan in 2012 to merge with Holy Redeemer Health System was scotched by community opposition to Abington’s willingness to stop performing abortions as a condition of merging with the Roman Catholic hospital.

For years, health-care experts have been predicting a wave of mergers in preparation for a time when health care is much less focused on hospitals than it is now, but the Philadelphia region has seen relatively little consolidation.

Abington and Jefferson are among the financially stronger systems in the region and could likely continue independently, Merlis and Klasko said, but merging now would give them a chance to prepare for the expected new world of health care from a position of relative strength.

By contrast, when Crozer-Keystone Health System, in Delaware County, announced last week it had hired an adviser to explore a possible merger, it was acting from the financially weak position of having lost $33 million in the year ended June 30.



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Death spiral? Short-term health plans grow as cheap alternative to ObamaCare


A short-term alternative to President Obama’s controversial health care plan could rob exchanges of the healthiest customers. (AP)

A fast-growing, short-term alternative to ObamaCare that allows customers to get cheap, one-year policies could put the government-subsidized plan into a death spiral.

The plans, the only ones allowed for sale outside of ObamaCare exchanges, generally cost less than half of what similar ObamaCare policies cost, and are increasing in popularity as uninsured Americans learn they are required to get health coverage. The catch — that the policies only last for a year — is not much of a deterrent, given that customers can always sign up for ObamaCare if their short-term coverage is not renewed.

“Applications rose 30 percent compared to last year,” Enrollment Specialist Carrie McLean told

Other providers said they also see rapid growth in the plans, which have a typical monthly premium of just over $100, compared to traditional plans that cost an average of $271.

“It’s because the product is typically half the cost of ACA plans, and you can chose any doctor or hospital,” Health Insurance Innovations CEO Mike Kosloske told

“It’s because the product is typically half the cost of ACA plans, and you can chose any doctor or hospital.”

- Health Insurance Innovations CEO Mike Kosloske

As long as customers stay healthy, they can renew the short-term plans. If patients get sick while covered, the plans provide for their care until the end of the term, when customers can be declined. But such plans can work well with ObamaCare, because if stricken policyholders can still buy insurance through the Affordable Care Act, where insurers must charge sick and healthy people the same rate.

Some people with these plans just buy them as a stop-gap between jobs or to wait until ObamaCare-approved plans go on sale again on Nov. 15. But Health Insurance Innovations says that 40 percent of people are repeat customers who buy one short-term plan after another.

In theory, if enough young and healthy people switch to short-term, non-ObamaCare plans, it could cause a “death spiral” for ObamaCare plans where prices soar and healthy customers look elsewhere.

“If the ObamaCare health insurance exchanges are to function properly, it is crucial that a substantial number of people ages 18-34 join them,” the National Center for Public Policy Research wrote in a study last year. “This age group that is young and relatively healthy must purchase health insurance on the exchanges in order to “cross-subsidize” people who are older and sicker. Without the young and healthy, the exchanges will enter a “death spiral” where only the older and sicker participate and price of insurance premiums will increase precipitously.”

However, supporters of ObamaCare say the program’s taxpayer-funded subsidies will keep customers from bolting.

“I really don’t think a lot of people are going to buy these policies because with these, people can’t get the financial assistance they can get in the [ObamaCare] marketplace,” Cheryl Fish-Parcham, Private Insurance Program Director at the pro-ObamaCare Families USA told

She added that, except for people in unusual circumstances, the short-term plans are not a good deal.

“There are a lot of protections that they are missing out on. For instance if you have pre-existing condition, you are going to be rejected. If you get pre-existing condition while on the plan, that insurer is not going to sell to you again.”

There is another catch to having short-term insurance: Customers still have to pay the tax penalty for not having ObamaCare insurance. That fine is $95 annually per person, although it has been waived for those who lost their insurance due to ObamaCare. But by the year 2016, it will rise to a more substantial $695 per person or 2.5 percent of your income (whichever is greater.)

But Kosloske of Health Insurance Innovations says even with the fine, it is still worth it for most people to go with temporary insurance for now, unless their income is low enough to qualify for the largest subsidies.

“Basically, people making $37,000 or less should go on ObamaCare. People with serious pre-existing conditions — they should go on ObamaCare. But for everyone else, including the penalties and including the subsidies [for ObamaCare plans], we cost 30-50 percent less and have that freedom of choice with providers.”

Health Insurance Innovations estimates that the short-term insurance industry as a whole has grown at 20-30 percent over the last year since ObamaCare was implemented and that it currently accounts for about 17.5 million policies.

McLean, of, said the plans appeal to young people.

“They’re particularly popular with young adults,” she said. “Forty-six percent of our short term policy holders are between the ages of 25 and 34.”

One conservative youth advocacy group, Generation Opportunity, specifically endorses buying short-term plans as a way to get around ObamaCare.

“We think it is an excellent option for young people,” the group’s president, Evan Feinberg, said, though he added that it isn’t perfect.

“We don’t think this is an ideal way to do health insurance in general. People should be free to insure themselves both against short-term catastrophic costs and the long term need for permanent medical care,” he said.

“Unfortunately there are people who take away that choice from us based on a misguided idea that they can run a healthcare system from Washington that meets the needs of hundreds of millions of Americans.”

Maxim Lott can be reached on twitter at @maximlott or at

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Obama’s Health Law: Who Was Helped Most

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Is Soda Really As Dangerous As Cigarettes? The Problems With This Month’s …

Despite this data fog, scientists drove on. More research led to more confusion: Both positive and negative associations were found between a person’s telomeres and the amount she smoked, drank, or exercised, and also with her body mass index. By now no fewer than 31 studies have been conducted on the possible link between telomere length and socioeconomic status, on the theory that the stress of being poor could make a person age more quickly. Some have claimed to find a real effect, but taken all together, the evidence is weak. According to a summary of the field from 2013, the only correlations that do seem to hold across the corpus of research are those that have to do with age, gender, and race. Our telomeres get shorter as we age—that much is certain. (Although we all start with telomeres of different lengths, and the rate of decline also varies.) It also seems that men have shorter telomeres than women, on average, and whites have shorter telomeres than blacks.

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Obama Says U.S. Should Embrace Health Workers Fighting Ebola In Africa

WASHINGTON — The United States shouldn’t do anything to discourage health care workers from traveling to Ebola-stricken countries, President Barack Obama said Tuesday in remarks that contrasted sharply with the actions of governors who have sought to quarantine doctors and nurses returning from West Africa.

“We don’t want to discourage our health care workers from going to the front lines and dealing with this in an effective way,” Obama said. “We have to make sure that we continue to provide the support of health workers who are going overseas to deal with the disease where it really has been raging.”

Obama also said he would meet Wednesday with health care workers en route to and returning from West Africa “not only to say thank you to them and give them encouragement, but to make sure we’re getting input from them, based on the science, based on the facts, based on experience, about how the battle to deal with Ebola is going and how our policies can support the incredible heroism that they are showing.”

Several times in recent weeks, Obama has gone out of his way to make personal contact with nurses caring for Ebola patients, going so far as to hug and kiss them to show he’s not afraid of catching Ebola.

It has been 13 days since the government last confirmed a person had contracted Ebola on U.S. soil, but the political response has only escalated since then.

Last week, New Jersey Gov. Chris Christie (R) and New York Gov. Andrew Cuomo (D) announced that people who had treated Ebola patients in Africa would be quarantined for three weeks when they returned to the U.S., even if they didn’t show symptoms of the virus. After facing waves of criticism from public health experts — and outrage from a healthy nurse quarantined in a tent behind a New Jersey hospital — the governors relaxed the policies, saying people could serve out their quarantines at home. Several other states have announced similar quarantine plans.

On Monday, the Centers for Disease Control and Prevention, which has already said it would actively monitor people traveling from West Africa, announced new guidelines recommending voluntary at-home isolation of anyone who’d been exposed to an Ebola patient. Experts say Ebola is only transmissible through close contact with an infected person’s bodily fluids, and an infected person is not contagious until they are suffering symptoms, which can be delayed for up to three weeks.

Epidemiologists and public health authorities, such as Dr. Anthony Fauci of the National Institute of Allergy and Infectious Diseases, have said restrictive policies like travel bans and forced quarantines could actually make the U.S. less safe from an Ebola epidemic, since preventing one depends on stopping the disease in West Africa, where it has killed nearly 5,000 and infected twice as many. The experts worry travel bans and quarantines could discourage health care workers from traveling to the region to help fight the outbreak.

“If we don’t have robust international response in West Africa, then we are actually endangering ourselves here back home,” Obama said Tuesday, adding that workers should be applauded for traveling to the epicenter of the outbreak. “We can make sure that when they come back, they are being monitored in a prudent fashion, but we want to make sure that we understand that they are doing God’s work over there.”

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Home Health Workers Struggle For Better Pay And Health Insurance

Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4.i

Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4.

Sarah Jane Tribble/WCPN, Ideastream

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Sarah Jane Tribble/WCPN, Ideastream

Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4.

Home health care workers Jasmine Almodovar (far right) and Artheta Peters (center) take part in a Cleveland rally for higher pay on Sept. 4.

Sarah Jane Tribble/WCPN, Ideastream

Holly Dawson believes her job is a calling.

She is one of about 2 million home care workers in the country. The jobs come with long hours and low pay.

Each workday, Dawson drives through the Cleveland suburbs to help people take their medicines, bathe and do the dishes. She also takes time to lend a sympathetic ear.

George Grellinger, a former client of hers, has dementia. He recently fell down the back steps of his home. Dawson remains friends and regularly stops in to check on him. To remain living at home, Grellinger had to switch to an aide who is covered by his veterans’ benefits.

When Dawson worked for him, Grellinger paid an agency $37 for two hours of her time each day. Dawson received $13 an hour, higher than the national average for home health aides. She had to pay her own taxes and health care benefits. Dawson says she can’t remember the last time she could afford health insurance

Dawson says she has been a home health aide for 31 years. She has never done it for the money, rather to help people like Grellinger, she says.

But the conditions of home health work are leading many aides to seek better pay and benefits.

On an early September morning, home health workers held a rally in Cleveland. Jasmine Almodovar, 35, chants with the crowd: “We want change and we don’t mean pennies!”

She says she earns $9.50 an hour, which is actually just above average for a home health worker in Ohio.

“We work really long hours, really hard work,” she says. “A lot of us are barely home because if we don’t go to work, we don’t get time off. We don’t get paid vacations. And some of us haven’t had raises in years.”

Carmen Smith, 44, shows son Roland, 6, her new perfume. The Cleveland resident says getting on Medicaid has made it much easier to manage her diabetes.

Almodovar says her last raise was four years ago. She makes about $21,000 a year so she makes too much to qualify for Medicaid, but paying for a plan on Ohio’s federal exchange doesn’t fit in her monthly budget.

“I don’t have a retirement plan, I don’t have life insurance, I don’t have medical,” she says. “Because by a government basis, I’m 90 percent above the poverty level — but I’m in poverty.”

Home care workers are mostly women. More than half are women of color, and 1 in 5 are single mothers. A recent analysis by the Brookings Institution found that while the ranks of home health workers grew exponentially over the past decade, their earnings dropped when accounting for inflation, says Martha Ross a researcher at Brookings.

“People aren’t shocked about a fast food worker not having health insurance,” she says, “But someone who is in the health care sector providing necessary health care who does not have health insurance? Just on the face of it, it’s wrong.”

Under the Affordable Care Act, there are financial incentives for hospitals and doctors to keep patients healthy. Ross says home care workers should be considered – and compensated – as vital front-line personnel in reaching the new goals.

And the U.S. Labor Department says more than a million new home care workers will be needed in the next decade.

“They can contribute to better care,” Ross says. “Down the line that can contribute to reduced costs through reduced hospitalizations or going back into a nursing home and over time you can take those savings and put them into increased earnings for that home care worker.”

Home care workers are often trusted advisors for the patients, says Lisa Kristosik with the Visiting Nurses Association of Ohio.

“People get real confused about how to navigate the health care system,” she says. “And they know because they’ve seen it. Because they’re in the homes. And they are in the homes for hours on end.”

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

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5000 Ebola Health Care Workers Needed in W Africa

APTOPIX Sri Lanka Ebola

Associated Press

More than 5,000 additional health care workers are needed to fight Ebola in the three most affected countries in West Africa, the president of the World Bank said Tuesday.

Jim Yong Kim said he is worried about where those health care workers can be found given the Ebola fear factor. The World Bank president spoke in Ethiopia alongside U.N. Secretary-General Ban Ki-moon and African Union chairwoman Nkosazana Dlamini-Zuma.

Ban said the transmission of the virus continues to outpace the international community’s response. He appealed for African Union member states not to impose Ebola-related travel restrictions or close their borders.

“We need to have a steady stream of health care workers from Africa coming into the three affected countries. The head of the U.N. Mission for Ebola Emergency Response, David Nabarro, has told us that we need at least 5,000 health workers from outside the region,” Jim said.

“Right now, I’m very much worried about where we will find those health care workers. With the fear factor going out of control in so many places, I hope health care professionals will understand that when they took their oath to become a health care worker it was precisely for moments like this,” he said.

Dlamini-Zuma said African Union states have pledged to send more than 2,000 health care workers into West Africa. She did not say when the workers would arrive.

“The disease, which is not new to the world, and its manifestations in these countries, has caught us by surprise. With the wisdom of hindsight, our responses at all levels — continental, global and national — were slow, and often knee-jerk reactions that did not always help the situation,” Dlamini-Zuma said.

Ebola has hit the West African countries of Liberia, Sierra Leone and Guinea the hardest. The outbreak has killed nearly 5,000 people.

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Health insurance basics for open enrollment

Open enrollment is coming up for individual health insurance under the Affordable Care Act, and if you are going to be shopping, you’re going to want as much information as possible.

This is especially true in Oregon, where we’ve provided so much coverage about Cover Oregon and its troubles that you might have a hard time deciphering how the news should affect your personal health decisions.

So with the help of the Oregon Insurance Division, I wanted to give you a few basic things to keep in mind as Nov. 15 quickly approaches. If you are not covered through your employer, or are considering options outside of what your employer provides, pay attention. Snip this out, put it on your fridge or email it to your friends.

Shop for the best

This is your chance to shop and find the best health insurance product for you. Gone are the days that your plan just rolls over into the next year, helpless to the changes in price or benefits your health insurance company might make. If you are receiving a letter in the mail telling you your rate is going up, and you don’t think it’s a good value for the product, then shop. If the past year’s benefits have not impressed you, then shop. If you’ve been happy, but still are curious if you could get a better deal, then shop. This might not have been possible for you before, and you might need some help navigating the market, but remember that the Affordable Care Act no longer allows companies to deny you coverage because of a pre-existing condition. That means you can shop for your health insurance the way you might shop for many other things in your life.

Patrick Allen, director of Oregon Department of Consumer Business Services, said Oregon has among the most competitive insurance marketplaces, with 11 carriers, making it a favorable shopping environment for consumers. But the trick will be in urging people to step away from what they’re used to and take advantage of their relatively new freedom as consumers.

“Every year is a separate purchase,” Allen said. “The plan offerings change, the prices change, and you should really each year take a fresh look at your choices.”

A good starting point, Allen said, is to be familiar with your health care spending in years’ past. Are you generally healthy and mostly use health care for check-ups and the occasional cold? Are you a cancer survivor? Do you have other chronic diseases that requires regular management and multiple prescriptions? Depending on your health care spending, there will be a different product that makes the most sense, Allen said.

You must re-enroll

If you are one of the more than 102,000 Oregonians who enrolled in private coverage through Cover Oregon, you have to re-enroll by visiting Allen says you should treat the process as if you were starting from scratch.

You will be able to register, sign up for an account and then browse health insurance plans.

If you’re eligible for Medicaid, you can also sign up on during this open enrollment period. The state is working on its own enrollment system for Medicaid members, but it will not be ready this year.

There will be some exceptions in the Medicaid crowd, who might have special circumstances that will send them to the state PDF form to apply for Medicaid.

If you’re currently in Medicaid and have received a renewal letter, you do need to take steps to enusre you stay covered. If your information — income or family size, etc — have stayed the same, you can do it by filling out a one-page form, according to Oregon Health Authority.

If you were enrolled through fast-track or have to account for changes in your eligibility determination, the full application must be filled out., (503) 399-6673 or follow at

Get help

The Oregon Insurance Division has more information about health insurance at and has consumer advocates available to answer questions toll-free at 1-888-877-4894.

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Quarantining health workers could worsen Ebola epidemic, officials say

Top Obama administration officials publicly warned Sunday that mandatory quarantines in the U.S. of doctors, nurses and other healthcare workers who have traveled to Africa to help Ebola patients risked worsening the epidemic.

Mandatory 21-day quarantines, now in place in New York, New Jersey and Illinois, are “a little bit draconian” and could discourage people from helping to fight the disease, Dr. Anthony Fauci, the top Ebola expert at the National Institutes of Health, said in several television interviews Sunday.

Fauci’s public remarks came as the administration privately pushed states to reconsider.

Related story: New York mayor criticizes New Jersey's 'disrespect' of Ebola nurse

New York Gov. Andrew Cuomo defended the quarantine policy during a Sunday night news conference, but outlined a version that appeared less onerous than the treatment that has been accorded so far to the one person in quarantine, in New Jersey. Cuomo and New Jersey Gov. Chris Christie had ordered the quarantine policy Friday but had left details unclear.

“My personal practice is to err on the side of caution,” Cuomo said. Healthcare workers returning to New York who were exposed to Ebola patients in West Africa would be required to stay home for three weeks, he said. The state would work with hospitals to encourage doctors and nurses to travel to Africa to fight the disease and, if necessary, would pay the salaries of healthcare workers while they were in quarantine, he added.

The three states with quarantine orders are among five with airports used by travelers arriving from West Africa. The other two states, Georgia and Virginia, have not taken similar action. Florida has ordered enhanced monitoring of people in contact with Ebola patients, but not a quarantine.

The federal government could soon propose new rules for dealing with returning healthcare workers that would not involve quarantines, a senior administration official said.

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As controversy grew over how to handle healthcare workers, the nurse who was the first person subjected to quarantine called her treatment in New Jersey “inhumane.”  New York Mayor Bill de Blasio said the nurse had been mistreated.

Kaci Hickox, a nurse and epidemiologist for Doctors Without Borders, returned from Sierra Leone on Friday and was detained at Newark International Airport. She has been held since then in what she described to CNN’s Candy Crowley as a “tent structure” outside University Hospital in Newark, N.J., with a port-a-potty and no shower.

“I feel physically completely strong and emotionally completely exhausted,” she said, noting that she has no fever or any other symptom of the disease. “This is an extreme that is really unacceptable, and I feel like my basic human rights have been violated.”

Doctors Without Borders said the tent was not heated, “and she is dressed in uncomfortable paper scrubs.”

Hickox’s lawyer, Norman Siegel, a former New York Civil Liberties Union executive director, said he would go to court to seek her release.

De Blasio likened her to a “hero, coming back from the front” — a word also used by Fauci and other administration officials. De Blasio said Hickox had been “treated with disrespect, was treated as if she has done something wrong, which she hasn’t.”

The mayor made his comments at a midafternoon news conference at Bellevue Hospital in Manhattan, where Ebola patient Dr. Craig Spencer is being treated. A spokesman for the hospital said the doctor was in “serious, but stable condition” and “looking a little bit better than he looked yesterday.” De Blasio also appeared with Cuomo Sunday night.

Earlier in the day, Christie defended the quarantine policy that he and Cuomo had ordered after Spencer’s diagnosis.

“I don’t believe that when you’re dealing with something as serious as this that we can count on a voluntary system,” Christie told “Fox News Sunday.” “This is government’s job. If anything else, the government’s job is to protect the safety and health of our citizens.”

After criticism of the nurse’s treatment, Christie’s office released a statement late Sunday that did not mention Hickox, who has a home in Maine.  

“New Jersey is not changing its quarantine protocol.   The protocol is clear that a New Jersey resident with no symptoms, but who has come into contact with someone with Ebola, such as a healthcare provider, would be subject to a mandatory quarantine order and quarantined at home,” the statement said. “Nonresidents would be transported to their homes if feasible and, if not, quarantined in New Jersey.”

The quarantine order from Cuomo and Christie requires 21-day confinement for anyone who has come into contact with Ebola patients in Sierra Leone, Guinea or Liberia, the three countries hardest hit by the epidemic.

They announced the move after Spencer, who had treated Ebola patients in Guinea, came down with the virus. Spencer had visited several places in the city, including a restaurant and a bowling alley, before developing a fever and contacting health officials on Thursday. Health officials have stressed that he was not contagious before developing symptoms.

Shortly after Christie and Cuomo acted, Illinois Gov. Pat Quinn issued a similar quarantine order. “This protective measure is too important to be voluntary,” Quinn said. “We will continue to take every safeguard necessary to protect first responders, healthcare workers and the people of Illinois.”

Fauci, the director of the National Institute of Allergy and Infectious Diseases, said that the public could be protected without going as far as a quarantine and that ordering people confined for an extended period could result in “unintended consequences.”

“Let’s not forget the best way to stop this epidemic and protect America is to stop it in Africa,” he said on ABC’s “This Week.”  “And you can really help [stop] it in Africa if we have our people, our heroes, the healthcare workers, go there and help us to protect America.”

A senior administration official, speaking anonymously in accordance with White House policy, said Sunday that the administration was working on new guidelines for returning healthcare workers. Administration officials had let Cuomo, Christie and other governors “know that we have concerns with the unintended consequences of policies not grounded in science may have on efforts to combat Ebola at its source in West Africa,” the official said.

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Choosing a Health Plan Is Hard, Even for a Health Economist

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