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Health-Law Opponents Seek Supreme Court Review

WASHINGTON—Opponents of health-insurance subsidies tied to the Affordable Care Act moved quickly Thursday to get an appeal in front of the Supreme Court.

The challengers, Virginia residents who objected to the subsidies, filed a petition with the high court just nine days after the Fourth U.S. Circuit Court of Appeals in Richmond, Va., upheld an Obama administration regulation that said subsidized insurance was available to qualifying…

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Work to Bolster Health Website Is Raising Cost, Officials Say

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Emergency Efforts in Africa to Contain Ebola as Toll Rises

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House Approves VA Health Care Overhaul

Associated Press

The House overwhelmingly approved a landmark bill Wednesday to help veterans avoid long waits for health care that have plagued the Veterans Affairs Department for years.

The $16.3 billion measure also would allow the VA to hire thousands of doctors and nurses and rewrite employment rules to make it easier to fire senior executives judged to be negligent or performing poorly.

The 420-5 vote sends the bill to the Senate, where approval is expected Thursday.

The bill includes $10 billion in emergency spending to help veterans who can’t get prompt appointments with VA doctors to obtain outside care; $5 billion to hire doctors, nurses and other medical staff and about $1.3 billion to lease 27 new clinics across the country.

The House vote came as former Procter Gamble CEO Robert McDonald was sworn in Wednesday to lead the sprawling agency, which provides health care to nearly 9 million enrolled veterans and disability compensation to nearly 4 million veterans.

McDonald, 61, of Cincinnati, replaces Sloan Gibson, who took over as acting secretary in May after Eric Shinseki resigned amid a growing uproar over reports of long veterans’ waits for health care and VA workers falsifying records to cover up delays. Gibson will return to his job as deputy secretary.

McDonald has pledged to transform the VA and promised that “systematic failures” must be addressed. He said improving patient access to health care was a top priority, along with restoring transparency, accountability and integrity to the VA.

Congressional budget analysts estimated the bill would cost about $16.3 billion over three years, slightly less than a $17 billion estimate provided by the bill’s sponsors.

The bill is expected to add $10 billion to the federal deficit over 10 years after cost-savings such as changes in a veterans’ retirement program and reimbursements by insurance companies are included, the nonpartisan Congressional Budget Office said.

Rep. Jeff Miller, R-Fla., chairman of the House Veterans’ Affairs Committee, said the reform bill was urgently needed in the wake of what he called “the biggest scandal in the history of the Department of Veterans Affairs.”

While the bill’s cost is steep, it is needed to ensure that veterans receive proper care, Miller said.

“The VA has caused this problem and one of the ways that we can help solve it is to give veterans a choice, a choice to stay in the system or a choice to go out of the system” to get government-paid health care from a private doctor, he said.

“No veteran should be forced to wait for the health care or benefits they have earned,” said House Minority Leader Nancy Pelosi, D-Calif., adding that the bipartisan bill “will help us serve our veterans as well as they have served us.”

Rep. Steny Hoyer of Maryland, the second-ranking Democrat in the House, said he was concerned about a provision in the bill that makes it easier to fire senior executives judged to be negligent or underperforming. Hoyer, whose suburban Washington district includes thousands of government workers, said the bill “undermines civil service protections that have been in place for decades.”

Existing protections “strike the right balance between giving agencies the authority to remove personnel without trampling on the due process rights of (senior) employees that they need to do their job without fear of political reprisal or arbitrary removal,” Hoyer said.

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Top Maryland health official Joshua Sharfstein to step down in January

Maryland’s top health official, Joshua M. Sharfstein, announced Wednesday that he will leave at the end of Gov. Martin O’Malley’s term in January to become an associate dean at the Johns Hopkins Bloomberg School of Public Health.

In nearly four years as secretary of the Department of Health and Mental Hygiene, Sharfstein has become one of O’Malley’s most trusted and visible Cabinet members while building a national reputation as an expert in public-health policy.

He is widely liked by many legislators for his ability to break down complicated health-care issues without becoming impatient or flustered. But Sharfstein became a lightning rod for criticism late last year after the disastrous debut of Maryland’s glitch-plagued online health-insurance exchange.

Sharfstein, a pediatrician who studied at Harvard, approached his government position not only as an administrator, but also as a health-policy wonk intent on lowering the number of preventable hospitalizations, reducing the number of infants who die, cutting health-care costs and helping more Marylanders live healthier lives.

The position at Hopkins, he said in a lengthy e-mail to employees Wednesday morning, “will allow me to stay involved in my city of Baltimore and my state of Maryland, while engaging with national and global challenges and helping to train a new generation of public health leaders.”

Vincent DeMarco, an activist and the president of the Maryland Citizens’ Health Initiative, said that Sharfstein has been “a really great asset for Maryland.”

Sharfstein’s public-policy background was no match, however, for the serious technology problems that plagued the state’s much-hyped insurance Web site, a major component of its implementation of the Affordable Care Act. The site crashed on its first day, struggled through a six-month enrollment period and is now being rebuilt.

“The IT problems of the Maryland Health Benefit Exchange last year are certainly not going to make my highlight reel,” Sharfstein said in his e-mail. “I do remember, however, the moment when Governor Martin O’Malley pulled me aside and told me that what mattered most was rising to the challenge.”

The dysfunctional site has also been a political liability for O’Malley, who is contemplating a run for president in 2016, and Lt. Gov. Anthony G. Brown, the Democratic nominee to replace O’Malley as governor.

Sharfstein became the face of the exchange, directly fielding calls from frustrated insurance carriers, lawmakers, reporters and others. He spent hours testifying before panels of local and federal lawmakers about what went wrong and why. When asked once whether he had grown tired of the grilling, Sharfstein responded that he enjoyed doing it.

And while O’Malley and Brown at first avoided issuing direct apologies for the debacle, Sharfstein did so repeatedly and profusely.

Larry Hogan, the Republican nominee for governor, said in a statement Wednesday that Sharfstein should resign immediately because of the problems with the exchange.

“Saying he plans to resign in January is hardly newsworthy,” Hogan said. “The Hogan-[Boyd] Rutherford administration would never allow this level of incompetence in one of the state’s most important agencies and would have demanded his immediate resignation in January anyway.”

Sharfstein said Wednesday that the exchange’s problems aren’t why he is leaving.

He listed among his accomplishments modernizing how Maryland hospitals set their rates, using data to tackle public-health problems, fighting drug and alcohol abuse and promoting domestic-violence screenings.

Sharfstein grew up in Maryland and graduated from Harvard Medical School. He was Baltimore’s health commissioner from 2005 to 2009, then principal deputy commissioner of the U.S. Food and Drug Administration. He returned to Maryland in January 2011 to become health secretary.

“It’s a really great job at a really important moment in time,” Sharfstein said in an interview when he was hired.

As Sharfstein announced his next job, O’Malley said in a statement: “As a Marylander, I’m thrilled that he’s going to Johns Hopkins.”

Sharfstein will become a full-time faculty member and the associate dean for public-health practice and training. He will replace Thomas Burke, who has held the position since 2008 and has been nominated by President Obama to lead the Environmental Protection Agency’s Office of Research and Development.

“We already know Josh from his lectures at our school, his mentorship of our students and our productive collaborations, and we look forward to his full-time presence and impact at the school,” said Michael J. Klag, dean of the school.

Also in his e-mail, Sharfstein told employees that he will remain “fully engaged in the tasks at hand” until January. His to-do list includes continuing to battle a spike in heroin overdoses and rebuild the insurance Web site.

“As we work together on these and other critical projects,” Sharfstein wrote, “there is no reason for goodbyes — just the opportunity to be sure our paths will cross again.”

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Health premiums soared, Insurance Commissioner Dave Jones says

The cost of health insurance for individuals skyrocketed this year in California, with some paying almost twice what they did last year, the state’s insurance commissioner said.

But Insurance Commissioner Dave Jones predicted that insurers will ease up in the coming year to prevent California voters from approving tough new rate controls on the November statewide ballot as Proposition 45.

Insurers and opponents of Proposition 45 dismissed Jones’ comments as misleading and politically motivated.

Related story: Obamacare rebates headed to thousands of consumers, employers

At a news conference Tuesday, Jones said individuals this year paid between 22% and 88% more for individual health insurance policies than they did last year, depending on age, gender, type of policy and where they lived.

The increases did not affect poor people, whose policies are heavily subsidized, Jones said. The study results released Tuesday did not include group policies such as those offered by employers.

Jones said he authorized the study of health insurance rates after receiving numerous complaints about rising costs.

lRelated Need for ballot measure on health insurance rate regulation debated
BusinessNeed for ballot measure on health insurance rate regulation debatedSee all related

“The rate increase from 2013 to 2014, on average, was significantly higher than rate increases in the past,” Jones said.

The hardest-hit were young people, he said. In one region of Los Angeles County, people age 25 paid 52% more for a silver plan than they had for a similar plan the year before, while someone age 55 paid 38% more, Jones said.

The state examined policies issued by the state’s four largest health insurers: Anthem Blue Cross, Blue Shield of California, Kaiser and Health Net.

Related story: Health law covers at least 8 million

Related story: Health law covers at least 8 million Chad Terhune, David Lauter Most Obamacare enrollees say they are happy with new insurance, data show. Most Obamacare enrollees say they are happy with new insurance, data show. ( Chad Terhune, David Lauter ) –>

Jones took time Tuesday to lobby for Proposition 45, a statewide initiative on the November ballot that would give his office new authority to regulate proposed health insurance increases. He said California is among a minority of states that do not regulate health insurance costs.

“We’re going to continue to see rates go up simply because … no one has the ability to stop excessive rates,” he said.

There was some good news: Jones said he expects 2015 increases will be lower. That’s because insurers won’t want to offend voters before they consider health insurance cost regulation, he said.

“There would be a huge public outcry, and the public would respond at the ballot box,” Jones said. “I have no question that what we’re going to see … will be much lower than would otherwise occur.”

Critics of Jones and Proposition 45 were quick to respond.

Robin Swanson, spokeswoman for Californians Against Higher Health Care Costs, which opposes the initiative, said Jones “is using this misleading report to promote a ballot measure that would give him vast new powers over healthcare decisions.”

The California Assn. of Health Plans, an insurer trade group, said in a news release that Jones’ criticism “fails to consider the fundamental changes to health insurance that caused some Californians to pay less and some to pay more for their health insurance and ignores other positive changes brought on by the Affordable Care Act.”

“Health plans are focused on working with Covered California to provide affordable premiums during the upcoming open enrollment period, while Commissioner Jones is looking backward,” said Charles Bacchi, the group’s executive vice president.

“His analysis doesn’t take into account subsidies, enrollees who are benefiting from the ACA, or acknowledge how the ACA has substantially expanded coverage and benefits while also changing the way premiums are priced.”

Copyright © 2014, Los Angeles Times

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Zoe Saldana Poses Nude For Women’s Health UK

Before rumors of her pregnancy surfaced this month, Zoe Saldana stripped down for the September 2014 issue of Women’s Health UK. While Saldana has yet to confirm any reports, her cryptic interview with the magazine seems to hint at baby news.

The “Guardians of the Galaxy” star spoke about her physical transformation:

“My body is less toned. I do look in the mirror and see things I don’t want. My first reaction is I breathe and I think, ‘I’m a woman, I’m 36, my body is changing,’” Saldana said.

But the actress says she’s learned to be confident with her changing body.

“I’m exactly where I want to be. I do feel beautiful in a way that even when I was working out a whole lot, I sometimes didn’t,” she said. “Because there have been times that I was really slender and I didn’t like that I sometimes looked a little too muscular and flat chested –- you’ll never be completely happy, so at the end of the day it’s like, fuck it. Just be happy, regardless.”

Hmmm. Us Weekly, E! News and The Hollywood Reporter have all reported that sources confirm Saldana is pregnant. If the rumors are true, this will be the first child for the actress and artist Marco Perego, whom she married last June in a secret ceremony.

Read the full interview with Zoe Saldana in the September issue of Women’s Health UK., on newsstands and available for digital sale July 30.

See the stunning images from Saldana’s photo shoot with Women’s Health UK below:

zoe saldana

zoe s

zoe s

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The Health Benefits of Trees

John “Johnny Appleseed” Chapman stomped through the Midwestern winter snow with bare feet. His cloak was a lightly modified coffee sack with holes for his head and arms that—all of this according to a posthumous 1871 profile in Harper’s—he deemed “as good clothing as any man need wear.” He ate from buckets of pig slop, and when people welcomed Appleseed into their log homes, he would lie on the floor and deliver “news right fresh from heaven.” He claimed to have frequent conversations with angels, two of whom promised to marry him upon his death if he agreed to abstain from marriage during his Earthly existence, which he did manage

But Appleseed was also wholly obsessed with planting trees for the benefit of future generations, so his legacy as an American folk hero is due. 

It is becoming increasingly clear that trees help people live longer, healthier, happier lives—to the tune of $6.8 billion in averted health costs annually in the U.S., according to research published this week. And we’re only beginning to understand the nature and magnitude of their tree-benevolence.

In the current journal Environmental Pollution, forester Dave Nowak and colleagues found that trees prevented 850 human deaths and 670,000 cases of acute respiratory symptoms in 2010 alone. That was related to 17 tonnes of air pollution removed by trees and forests, which physically intercept particulate matter and absorb gasses through their leaves.

As you might recall from the June 1862 issue of The Atlantic Monthly, Henry David Thoreau wrote, “I cannot preserve my health and spirits unless I spend four hours a day at least—and it is commonly more than that—sauntering through the woods and over the hills and fields, absolutely free from all worldly engagements.”

Thoreau may have been less liberated than Appleseed, but that is still a lot of sauntering. It’s more time than most of us feel comfortable investing in sauntering. Luckily it’s also more than is necessary to benefit from the coddling of our wooden keepers, which are incessantly protecting us from disease by ameliorating the air pollution we heap onto them. I emailed lead researcher Nowak for comment on his new findings but received an out-of-the-office reply, perfectly.

The culmination of the research is the map below, delineating where trees are most protective. In general, the more trees are in an area, the more pollution those trees remove. But they also remove more pollution-per-tree in areas where population density is high, and the health value derived from pollution removal is highest in urban areas.

Air Pollution Removal by Trees

 Removal of pollutants (NO2, O3, PM2.5, SO2; tonnes per sq. km) by county (Environmental Pollution)

“In terms of impacts on human health, trees in urban areas are substantially more important than rural trees due to their proximity to people,” the researchers wrote. “The greatest monetary values are derived in areas with the greatest population density (e.g. Manhattan).” (Brooklyn trees are less concerned with monetary values and more with effortless authenticity.)

When the emerald ash borer began ravaging thousands of trees in the American Midwest, as Lindsay Abrams noted in The Atlantic last year, rates of human death from cardiovascular and respiratory illness increased. One study monitored disease rates in 15 states from 1990 to 2007, where the borer was associated with 6,113 human deaths from illness of the respiratory system and 15,080 deaths from heart disease. And those medical outcomes don’t even include the known psychological merits of tree proximity. In one famous 1970s study of patients recently liberated of their gall bladders in a Pennsylvania hospital, those whose rooms had a view of trees recovered more quickly than those looking out at another building. Medical technology is far from developing any device that can help people recover from purposeful incisions to the abdomen just by looking at it. 

(Kara Gordon/The Atlantic)

Another medical study found that women recently diagnosed with breast cancer were better able to focus their attention if they spent two hours a week in natural environments, ostensibly because of stress mitigation.

Nowak, just as incapable of fully disconnecting as anyone, replied to me shortly after his automated response. “The takeaway is that trees have a huge impact on pollution,” he told me by phone, “and when populations increase, trees have a greater impact based on being close to where people live.”

“We need to start having this discussion,” Nowak said, referring to factors more quantifiable than did Thoreau, “about the impact of trees on human health.” 

Before designing urban landscapes simply to optimize air-pollution removal, Nowak said, we’d do well to also consider other benefits of trees related to energy conservation, like changes in air temperature, water, and wildlife. “There are a whole bunch of other things to consider. We’re talking billions of dollars a year [in benefit] from urban forests. It adds up, if you look at the whole picture.”

Air pollution now kills around seven million people every year globally, according to the World Health Organization. Factoring in the other costs of air pollution—not just to human health, but building and material damage and crop losses—Nowak’s current study put the total annual value of pollution removal by U.S. trees at $86 billion. 

Public-health researchers are to the point of suggesting people who live in high-pollution areas eat broccoli as a form of “chemoprevention” because it causes us to excrete benzene through our urine. The health argument for investing in trees, particularly of the urban variety, is even more staid. If you’ve ever scoffed at someone for calling a tree “majestic” or dismissed Johnny Appleseed as “just some crazy guy,” maybe it’s time to do some soul searching. And where’s this anger coming from? Not enough trees, probably.

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A Health Trade-Off That’s Here to Stay: Lower Cost, Limited Choice

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VA deal: $17B for health program

WASHINGTON — A bipartisan deal to improve veterans’ health care would authorize at least $17 billion to fix the health program scandalized by long patient wait times and falsified records covering up delays, the bill’s chief supporters said Monday.

The agreement includes $10 billion in emergency spending to make it easier for veterans who can’t get prompt appointments with Veterans Affairs doctors to obtain outside care; $5 billion to hire doctors, nurses and other medical staff; and about $1.5 billion to lease 27 new clinics across the country, the chairmen of the House and Senate Veterans Affairs committees said.

The bill also would expand a scholarship program for veterans to include surviving spouses of military members who died in the line of duty, allow all veterans to qualify for in-state college tuition, and grant the Veterans Affairs secretary authority to immediately fire senior executives, while providing employees with streamlined appeal rights.

The bill “makes certain that we address the immediate crisis of veterans being forced onto long waiting lists for health care,” said Sen. Bernie Sanders, I-Vt., chairman of the Senate Veterans Affairs panel. The bill also “strengthens the VA so that it will be able to hire the doctors, nurses and medical personnel it needs so we can permanently put an end to the long waiting lists,” Sanders said at a news conference with Rep. Jeff Miller, R-Fla., his House counterpart.

Miller said the bill would “go a long way to resolve the crisis” that is gripping the Department of Veterans Affairs. The agency has been rocked by reports of patients dying while awaiting treatment and mounting evidence that workers falsified or omitted appointment schedules to mask frequent, long delays. The resulting election-year firestorm forced VA Secretary Eric Shinseki to resign in late May.

Sanders and Miller reached agreement on a plan to reform the VA over the weekend after more than six weeks of sometimes testy talks.

The compromise measure would require the VA to pay private doctors to treat qualifying veterans who can’t get prompt appointments at the VA’s nearly 1,000 hospitals and outpatient clinics, or those who live at least 40 miles from one of them. The bill would limit the number of veterans who can get outside care by restricting it to those who are enrolled as of Aug. 1.

The proposed restrictions are important in controlling costs for the program. Congressional budget analysts had projected that tens of thousands of veterans who currently are not treated by the VA would likely seek VA care if they could see a private doctor paid for by the government.

The deal requires a vote by a conference committee of House and Senate negotiators, and votes in the full House and Senate.

White House press secretary Josh Earnest said President Barack Obama welcomes the bipartisan deal. “There are much-needed reforms that need to be implemented” at the VA, Earnest said.

The White House is especially pleased that the bill includes emergency spending “to provide VA the additional resources necessary to deliver timely, high-quality care to veterans through a strengthened VA system,” Earnest said.

An updated audit by the VA this month showed that about 10 percent of veterans seeking medical care at VA hospitals and clinics still have to wait at least 30 days for an appointment. About 46,000 veterans have had to wait at least three months for initial appointments, the report said, and an additional 7,000 veterans who asked for appointments over the past decade never got them.

Acting VA Secretary Sloan Gibson has said the VA is making improvements, but said veterans in many communities still are waiting too long to receive needed care. The VA provides health care to nearly 9 million enrolled veterans.

The House and Senate are set to adjourn at the end of the week until early September, and lawmakers from both parties have said completing a bill on veterans’ health care is a top priority.

The Senate is expected to vote this week to confirm former Procter Gamble CEO Robert McDonald as the new VA secretary, replacing Gibson.

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