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Looking at Costs and Risks, Many Skip Health Insurance

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Lilly eyes emerging markets in Novartis animal-health deal

PARIS/NEW YORK (Reuters) – The purchase of Novartis’ animal-health business will strengthen Eli Lilly’s hand in emerging markets, tapping into growing demand there for protein-rich diets and household treatments for pets, top executives of the U.S. company said.

As part of a multibillion-dollar revamp announced earlier on Tuesday, Swiss drugmaker Novartis said it would sell its animal-health arm to Indianapolis-based Lilly for about $5.4 billion, while also swapping assets with GlaxoSmithKline.

Lilly said the deal would turn its Elanco unit from the world’s No. 4 animal-health group by revenue to the global No. 2 in a sector that supplies medicines, vaccines and feed additives for farm and domestic animals. The sector’s biggest operator is Zoetis, spun off by Pfizer last year.

The Lilly unit posted sales of $2.15 billion in 2013, up 6 percent on the year, compared with about $1.1 billion for Novartis’ animal-health activities. Eli Lilly’s total sales were $23.1 billion.

“Elanco has doubled its sales and tripled its profits between 2007 and today, and this acquisition really brings it into the top tier of companies,” Lilly Chief Executive John Lechtleiter said in an interview. Other top players include U.S. drugmaker Merck Co and France’s Sanofi.

Thanks to vaccines and anti-parasite medicines from the Novartis deal, Lechleiter said Elanco will now be able to provide products for aquaculture, or fish farms, which he called “a different type of animal protein that we’ve wanted to get into.”

Elanco is also expanding its presence in eggs, through its planned acquisition of Germany’s Lohmann Animal Health.

“This (Novartis) deal really allows us to get a significant increase in our footprint in emerging markets and in our protein business on the food animal side this will be very important for us,” Jeff Simmons, Eli Lilly’s senior vice president and president of Elanco, told Reuters.

Elanco’s products include its Elector PSP to kill flies and beetles in cattle sheds, and the Rumensin feed supplement to boost productivity of dairy and beef cows. Novartis’ products range from its Atopica treatment for dermatitis in dogs and cats and its Denagard antibiotic for pigs and poultry.

Lilly sees the dairy, fish and egg sectors as products emerging market consumers turn to for protein before shifting towards meat, Simmons said.

“I believe these emerging markets and these emerging diets – eggs, fish, dairy – are key.”

Elanco has been seeing “high single-digit” growth rates in emerging markets and the Novartis deal would make it the No. 3 player in these countries versus No. 5 currently, he added.

The deal could also ease Elanco’s economic reliance on the livestock commodities markets such as cattle and hogs – which have roiled in recent years amid volatile grain prices, extreme weather patterns and shrinking herd sizes in the U.S.

“It takes us away from the meat cycles, where every four to five years, we ride the same (economic) rollercoaster that the meat producers do,” Simmons said.

The Novartis deal crowns a period of fast expansion for Elanco, whose operating profit margins rose to 26 percent last year – which Lechleiter said were comparable to margins of human prescription drugs.

Emerging market demand in animal health also reflected a growing trend for keeping pets, Simmons said, noting this had helped make its flea and heartworm brands big growth drivers at Elanco.

“Cities like Sao Paulo and Hong Kong are becoming more of a pet opportunity and that will continue to grow and expand,” Simmons said.

Pets represent about 40 percent of the global animal-health market, versus around 60 percent for farm animals, and Elanco would become the No. 3 player in the pet health segment following the Novartis acquisition, he said.

(Additional reporting by Natalie Huet; in Paris and PJ Huffstutter in Chicago. Editing by Andrew Callus, Mark Potter and Chizu Nomiyama)

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Change Your Income, Change Your Health Insurance Plan

People can change their insurance plan if their income levels change.


People who qualified for subsidies under the Affordable Care Act aren’t necessarily locked into the plan they chose. And that can be good news for people whose income fluctuates during the year. Here’s our response to the latest reader questions on coverage through the health exchanges.

Do you have any idea how the exchanges will administer changes throughout the year? Our current income is about $38,000 per year, which qualifies us for an enhanced silver plan. My husband often gets seasonal construction work, and that can increase his income to about $65,000. When he reports that change in income, will he be required to stay in the enhanced silver plan and pay the full cost, or can he switch to a lower-cost plan that he can afford?

From your description of your plan and your income, it sounds as if you and your husband currently qualify for both cost-sharing subsidies and premium tax credits. The subsidies are available to people with incomes up to 250 percent of the federal poverty level (currently $38,775 for a couple), and the tax credits are available to those who earn up to four times the poverty level ($62,040 for a couple).

The premium tax credits lower the sticker price and can be applied to any of the four plan types. The cost-sharing subsidies can reduce deductibles, copays and out-of-pocket costs for insurance bought on state and federal exchanges, but are only available to people who buy silver-level plans.

The tax penalty is designed to encourage people to sign up for health insurance.

If your husband’s income rises above 250 percent of the poverty level, however, you’d lose those cost-sharing subsidies. Then your out-of-pocket costs for copayments for doctors’ visits or for prescriptions, for instance, could be less affordable. And if your income reaches $65,000 you’d no longer qualify for premium tax credits. In that case, you might want to switch to a bronze plan with a lower premium, says Cheryl Fish-Parcham, private insurance program director at Families USA, a consumer advocacy group.

And you can do that. Under the health law, if your eligibility for cost-sharing subsidies changes you have 60 days to switch from one marketplace plan to another. A similar though broader rule applies to eligibility for premium tax credits, enabling people to switch plans or enroll for the first time if they aren’t already on the exchange.

How will we prove to the government that we have health insurance?

Until the federal income tax forms for 2014 become available, it’s not clear exactly what people will be required to report. However, it’s likely that “people will be asked for information about coverage and attest to it in the same way they do other information on their [tax] returns,” says Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities.

The health law requires employers and insurers to report information to the Internal Revenue Service about the coverage they provide, and also provide that information to individuals. The reporting requirement originally was slated to begin in 2014, but it has been postponed until 2015.

Tax credits may help make health insurance more affordable, but can bite back if your income goes up more than expected.

Most people will face a tax penalty in 2014 if they don’t have health insurance through employers, federal programs such as Medicare or Medicaid, or insurance they have purchased themselves.

It’s unclear if the government will eventually cross check the information it receives from employers and insurers against individuals’ self-reported coverage claims.

But even if that doesn’t happen, “you sign your return under penalty of perjury,” says Solomon. “You always can be audited and required to show proof” of coverage. “That’s the main thing.”

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The Public Health Crisis Hiding in Our Food

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Saudi Arabia Removes Health Minister as Deadly Virus Spreads

Saudi Arabia removed its health
minister from his post as the country struggles to combat an
outbreak of a deadly respiratory virus.

Abdullah al-Rabeeah was relieved of his duties and will
become an adviser to the royal court, the official Saudi Press
Agency said late yesterday. He’ll be replaced on an acting basis
by Labor Minister Adel Faqih, the SPA said.

Saudi Arabia says 19 people in Jeddah and Riyadh have
tested positive for the coronavirus, which causes Middle East
respiratory syndrome, or MERS, since April 18. Al-Rabeeah said
at a press conference in the capital on April 20 that total
cases have risen to 244, and the government expects more. At
least 93 people have died of the disease since it emerged in
Saudi Arabia in September 2012, according to the World Health

The virus has spread to Southeast Asia, killing a Malaysian
man who visited Saudi Arabia and infecting a Filipino health-care worker returning from Abu Dhabi, the WHO said last week.

Al-Rabeeah said at the press conference that the government
is ready for the Hajj season, when pilgrims from all over the
world converge on the desert kingdom. In October last year,
about 2 million people made the pilgrimage to Mecca, according
to Saudi officials.

The Saudi health ministry sent text messages to the
country’s 30 million residents last week to alert them about the
disease. The virus doesn’t spread easily between people, and no
cases have been observed related to crowds, in schools or at
football stadiums, the SPA cited a ministry official as saying.

To contact the reporter on this story:
Deema Almashabi in Riyadh at

To contact the editors responsible for this story:
Andrew J. Barden at
Ben Holland, Robert Tuttle

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How Your Office Is Harming Your Health

Many of us spend a large chunk of our waking lives at work, but rarely do we give much thought to how our on-the-clock environment might be affecting how we feel around the clock.

If the recent literature has anything to say about it, working in offices could be making us feel pretty crappy. Open office plans (and cubicles, to a certain extent) may be the worst offenders when it comes to harming employee wellness and productivity, and some studies on the fallbacks of the popular design have called the entire structure of American work life into question.

“The thinking goes that employees will be happier and more productive if they work together instead of being separated by thick office walls. Except they aren’t,” Fast Company wrote of the open office trend. “Far more workers stuck in cubicles and open office spaces are dissatisfied with their work environments than people in enclosed private offices.”

As a result, flexible work schedules and alternative office designs that incorporate greater privacy and calming elements are becoming more desirable and commonplace alternatives to spending 40+ hours a week in a cubicle or on an open office floor. And with entrepreneurial and freelance career paths becoming viable options for more American workers and some millennials ditching the 9-to-5, a redefining of the American workplace may indeed be slowly underway.

The negative impacts of various office environments on health and productivity alone provide a compelling argument for the need to change the way we spend our work days. Here are five ways working in an office could be harming your health and happiness.

Open offices could be making you unproductive and unhappy.

A 2011 review of studies examining the effects of various types of office environments found that open offices — though they do tend to foster a spirit of innovation and a collective mission — can have a negative impact on workers when it comes to focus, productivity, creativity and job satisfaction, the New Yorker reported. Employees in open offices may also experience higher stress levels and less concentration and motivation than those working in standard offices. This may be in part due to the fact that interruptions are more frequently experienced by employees in open offices, which can be a major hindrance to productivity.

A 2013 study of 42,000 U.S. workers also found that employees with private offices were more satisfied at work than those who worked in open spaces.

Your work environment could be upping your stress levels.

More than eight in 10 U.S. workers report being stressed about their jobs, and a recent poll found that 42 percent of U.S. workers have left a job due to an excessively stressful environment. The same poll also found that 61 percent of American workers believe that work stress has been a cause of illness for them.

The physical office environment could play a significant roll in spiking stress levels for some workers.

A Cornell study, cited by the New Yorker, also found that workers who were exposed to the noise level of an open office for three hours had higher levels of the hormone known as adrenaline, which is associated with the body’s stress response.

You may be more susceptible to getting sick.

One in four U.S. employees goes to work sick, according to a recent survey by NSF International, and particularly in an open office environment, it’s easy to see how colds can get passed around.

A 2011 Danish study suggested that number of sick days taken is positively correlated with the number of inhabitants in a space. Occupants of open offices had 62 percent more sick days than those who worked in cellular offices, the researchers found.

Poor air quality can also contribute to illness. The air inside a commercial building can sometimes be up to 100 times more polluted than the air outside, Bloomberg Businessweek reported.

A noisy workspace could be killing your concentration.

With phones ringing and colleagues chatting, typing and moving around, open offices are notoriously noisy and distracting — and the sound levels can have a significant impact on worker well-being. A 2006 UCSF study found that workers in open offices were more likely to perceive noise than those in cellular offices, in addition to temperature-related discomfort and poor air quality.

Noise-related distractions in open offices are the “enemy of focus,” Diane Hoskins, co-chief executive of the Gensler architecture firm, told the New York Times, adding, “It’s meaningful time that’s being lost.”

A sedentary lifestyle increases your risk of disease.

We’ve all heard that “sitting is the new smoking,” and it might actually be true: Your desk job could literally be killing you.

In many offices, sitting at a desk in front of a computer screen is the only acceptable way to go about your everyday work. Research has linked a sedentary lifestyle — the kind many desk jockeys lead — with a higher risk of diabetes and cardiovascular events. Sitting at a desk all day can also contribute to aches and pains, while staring at a computer screen for hours on end can trigger vision problems and headaches.

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Rail workers’ health issues are a growing safety concern

Visibility was 10 miles and the morning sun had pushed the temperature close to 90 as Danny Joe Hall guided his mile-long Union Pacific freight train east through the grasslands of the Oklahoma Panhandle.

Near the farming town of Goodwell, federal investigators said, the 56-year-old engineer sped through a series of yellow and red signals warning him to slow down and stop for a Los Angeles-bound train moving slowly onto a side track.

The 83-mph collision killed Hall and two crewmen. Dozens of freight cars derailed, and the resulting inferno sent towers of black smoke over the plains, prompting the evacuation of a nearby trailer park.

As it turned out, Hall was colorblind.

The National Transportation Safety Board’s subsequent probe of the June 2012 wreck faulted the engineer’s deteriorating eyesight and inadequate medical screening that failed to fully evaluate his vision problems.

But the Goodwell crash underscored a far larger concern: Railroads are the only mode of U.S. commercial transportation without national requirements for thorough, regular health screenings to identify worker ailments and medications that could compromise public safety.

Crash investigations have linked train accidents to railway workers’ health problems. The Goodwell crash and a rear-end collision in Iowa in 2011 that killed an engineer and conductor are among those that authorities believe could have been prevented with more rigorous medical testing of train crews.

Federal investigators are examining whether an engineer’s severe case of undiagnosed sleep apnea — a condition that can cause fatigue — contributed to last year’s derailment of a New York commuter train that killed four passengers and injured 59. Union and legal representatives of the engineer have said he either nodded off or went into a daze before heading into a 30-mph curve at 82 mph.

The NTSB found that the engineer’s doctors never evaluated him for the condition, and medical guidelines provided to employees by the Metro-North Railroad did not mention sleep disorders.

“The problems are not getting fixed, and more significant risks could occur as the population of railroad workers ages,” said Mark Rosekind, an NTSB board member.

In contrast, airline pilots, truckers, bus drivers and maritime professionals must undergo medical examinations with stricter requirements annually or every few years. In those industries, more frequent evaluations are required for workers over 40 or who have chronic medical conditions that can worsen.

Severe allergies, heart disease, poor vision, sleep disorders and diabetes — as well as use of medicines with serious side effects — are among the health issues that can disqualify workers if the conditions can’t be adequately controlled.

Since 1988, the NTSB has pushed unsuccessfully for similar standards for more than 100,000 locomotive engineers, conductors and other railway workers. But the Federal Railroad Administration, which oversees the industry, has balked at imposing mandatory, comprehensive medical requirements.

Working with unions and carriers, the FRA has opted for non-mandatory education programs for rail workers, formal advisory notices and other strategies to reduce risks associated with health problems.

“The FRA is committed to ensuring that train operators are fit for duty,” said agency spokesman Kevin F. Thompson. The administration “continues to work with labor and industry to comprehensively address standardized medical practices.”

Currently, engineers and conductors are required to pass vision and hearing tests every three years. In a statement, Union Pacific, which employed the engineer faulted by the NTSB in the Goodwell crash, said it complies fully with current federal standards. Train crews also undergo random testing for alcohol and illegal drug use.

Railroads typically require physical exams when someone is offered a job, as well as after an extended medical leave or when an employee’s health is questioned at work. In addition, railroad medical departments offer wellness programs.

Some rail carriers, either on their own or after NTSB crash investigations, have voluntarily adopted measures that exceed federal standards, including obtaining medical histories of employees and educating workers about sleep disorders and medications. Amtrak, for example, requires annual medical examinations for engineers.

The FRA’s Thompson said current regulations and voluntary industry screening programs have contributed to a steady decline in railroad accidents. The last two years have been among the safest for the industry, and Thompson noted that no fatal train wrecks linked to the health problems of train operators occurred between 2002 and 2010.

However, NTSB officials, safety experts and former FRA officials say there is ample evidence that current practices, which put much of the onus to disclose serious medical problems on workers, need to be strengthened.

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Wilmington VA medical center cuts wait for mental health help

Two years ago, veterans seeking mental health care at the Wilmington Veterans Affairs Medical Center were waiting far longer than the agency’s two-week standard to be assessed, and as many as two months before beginning therapy.

Those delays have been shortened considerably. New patients – save those considered as emergencies – who ask to be assessed specifically for mental health issues get their first appointment in an average of 6.5 days after enrollment, says Robin Aube-Warren, the center’s brand new director. They begin their treatment plans within 10 days after that assessment – five fewer than in 2012.

Overall, the average wait time for newly enrolled veterans to be seen by a primary care provider at Wilmington is 11 days. Primary care referrals are typically the way vets are sent to mental health treatment, she said.

“We have improved in our timeliness,” said Aube-Warren, who just completed her fourth week on the job, although she served as interim director for two months last summer.

She said she couldn’t comment on Wilmington issues that arose before she arrived. “We exceed most of the performance measures. We have hired additional staff in the mental health arena. … We’ve beefed up our staff.”

A total of 4,900 veterans receive some sort of mental health treatment at Wilmington.

The staffing increase was part of VA’s 2012 initiative to hire 1,600 more mental health clinicians and 300 additional support staffers nationwide in response to complaints of treatment delays. Wilmington is authorized to have 60 mental health providers on staff and currently has 57, with “two more in the pipeline,” Aube-Warren said.

Those with pressing needs who say they are veterans and show up asking for help are not turned away, even if they’ve never been seen.

As they are treated, the VA checks their eligibility. If for some reason that can’t be done immediately, she said, they’d still receive treatment.

“We would tell you that while we’re not able to verify you as a veteran right now, you clearly need help, and we’ll see you [on] a humanitarian basis,” she said. Those not eligible – dishonorably discharged veterans, for instance – would be billed for services.

The appointment delays were documented in an April 2012 review by VA’s inspector general, who found that about half of all mental health patients were evaluated within two weeks; the rest waited about seven weeks. The previous year, VA had claimed that 95 percent of first-time patients received a full mental health evaluation within 14 days.

Wilmington’s veteran population has risen as well, she said.

As it is, Vietnam veterans make up nearly half of the patients seen at Wilmington – 49.44 percent. Aube-Warren wants to see more of them.

“There was a lot of distress and dissatisfaction after the war, with the VA. … And so I think we’re still dealing with those stigmas. A lot of people aren’t willing to give us a chance. And VA health care has improved dramatically and amazingly.”

Significant health care issues at certain VA medical centers over the past several years have made bigger headlines. Preventable patient deaths at the center in Atlanta and a deadly Legionnaires’ disease outbreak in Pittsburgh that left five veterans dead, for example, have drawn angry calls for better care, better management and more accountability from, among others, the House Committee on Veterans’ Affairs.

Wilmington has managed to stay clear of such problems. Aube-Warren said Wilmington last year was the only hospital in the U.S. to receive zero recommendations for improvements from the Long Term Care Institute, a quality review group out of Madison, Wisc. She also pointed to Wilmington’s “top performer” rating on three different quality measures from the nonprofit Joint Commission, awarded two years running.

Aube-Warren brings more than a fresh face to Wilmington leadership. She’s also a military veteran, having spent 3½ years on active duty as an airborne military police officer. She deployed three times during that span and took part in the 1989 U.S. invasion of Panama. She retired from the Army Reserve at the rank of major in 2006.

She downplayed any advantage that might give someone charged with overseeing health care for veterans. But she knows it matters to them.

“I think it does bring a kinship, a common language, the ability to relate to a lot of what they have. And it is a brotherhood. I mean, there’s a very small percentage of us that have actually served. And I think it means something to the veterans that I’ve shared that.

“So I think that it perhaps makes things a little easier,” she said. “They know that I have their back – that I’ve been there, and I care about ’em.”

Contact William H. McMichael at (302) 324-2812 or On Twitter: @billmcmichael

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Health Law Fund-Raising Is Detailed

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Keeping your health information safe and secure

“Let’s talk health care.”

That short sentence has sparked some of the most engaging social, economic, ethical and political conversations over the past few years, and the conversations keep on coming. You’d be hard pressed to find someone who hasn’t attended a networking event, read an opinion piece or spent a night at the family dinner table tackling the issue of health care within the last month.

In the technology sector, the health care conversation always comes back to security. As a general advocate for online and electronic privacy, I strongly believe it’s your and my right to keep our health information private.

As a business leader, I understand that “right” isn’t a given, but something organizations have to work at every day to keep up with evolving technology and compliance. Keeping PHI (Protected Health Information) safe requires a managed IT process and data handling policies.

The Health Insurance Portability and Accountability Act of 1996 places limits on how your health information can be used and shared. HIPAA at first lacked enforcement provisions, so in 2009, the federal government enacted the Health Information Technology for Economic and Clinical Health Act, which gave HIPAA teeth by enacting audit provisions and nasty monetary penalties.

According to the U.S. Department of Health and Human Services’ data on HIPAA breaches affecting 500 or more individuals, 52 percent of PHI breaches are caused by theft. The second-most likely cause of a breach is unauthorized access or disclosure (17 percent).

Understandably, mobile technology has thrown a wrench into HIPAA compliance. Fifty-five percent of the devices involved in HIPAA breaches affecting 500 or more individuals were mobile (laptops, tablets, smartphones, etc.), followed by desktops (22 percent), network servers (17 percent) and email (6 percent).

So what can we do about this? Organizations can work with a security expert to assess and mitigate their compliance risks, and consumers can help protect their information as well.

Here are three things you can do:

1. Don’t share your health information with organizations not covered by HIPAA. HIPAA regulates health care providers and insurance companies, but it doesn’t cover all organizations billing themselves as “health” entities these days. For example, if you’re using applications like WebMD or MyFitnessPal and posting health problems on the apps message boards, you need to understand that this information isn’t protected by HIPAA.

2. Protect your home computers. If you use your home computers to store or access health information online — or if you’re using email to discuss a health issue — be sure these devices and applications are protected with strong passwords. Your passwords should be at least eight characters long and include special characters, letters and numbers, with a mix of upper- and lowercase. Never auto-save passwords, and be sure to change them every 90 days.

3. Don’t forget your paper files. While this column focuses on technology, decidedly nontech things like hospital bills, insurance statements and prescription drug bottles can put your private information at risk as well. Before you discard, shred these paper files.

James Fields is owner and president of IT service provider Concept Technology and IT staffing company Scout Staffing. Visit Concept Technology online at and Scout online at

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