Obese smokers who have no insurance. . . OOOOOklahoma is the place to be!

Can you hear the song in your head?  Yes, it seems that yet another article has been written about Oklahoma's poor health.  Nearly one-third of its citizens are obese, many smoke, and many don't have health insurance.  What does this mean?  The rest of us in this highly conservative, gun-toting state are carrying the medical costs of those people who don't take care of themselves and who protest the individual mandate of the ACA (lest they actually receive preventative care and have to pay something).  Separating my call for some sense of fiscal and personal responsibility from the health issues, I'm going to try to focus on the public health issue of obesity that is at hand.  The Gazette's article quotes the OK Commissioner of Health as saying that parents don't know how to recognize obesity in their children;  this is a real issue.  I would have never thought that education about classification of obesity would be necessary, but it appears it is.  This sounds like part of a good practicum experience for our MPH students at the OU College of Public Health.  Of course, as with anything in Oklahoma, you're going to have to deal with various cultures.  In addition to Caucasians, African-Americans, and Hispanics, there is also a sizeable Native American population.  Differing cultural techniques will need to be used to educate people about obesity.  Let's face it, you can't just waltz in and call someone's kid fat and leave. 

Linked with the recognition issue (and needing to do it tactfully and after building trust), I've noticed since living here that people do not make wise choices in the grocery stores.  I often see people buying many processed foods, already made foods, high in sugar foods . . . you name it.  Although there would definitely be an initial air of paternalism, it's almost like people need to have health educators go to the grocery with them, help them pick out healthy foods, and then teach them how to quickly prepare such foods.  As someone who grew up eating McDonald's, canned ravioli, boxed macaroni and cheese, and frozen dinners, I can vouch that the change in palatte takes time, but it can happen.  I now eat almost no prepared foods, I cook with very little salt, and I eat many fresh fruits and veggies . . . and I LOVE it!  Even into college, I would eat brownies or cake from a box regularly, but now I can take all the synthetic ingredients.  It just doesn't even taste good to me.  This change can happen for others.  Again, perhaps this education, grocery shopping, and cooking lesson is a good practicum project for an MPH . . .  we'll see.  Either way, Oklahoma needs to make a change because its people are just huge.  Jaime Oliver, are you listening?  (http://www.jamieoliver.com/us/foundation/jamies-food-revolution/home)

Read the Oklahoma City Gazette article here:  http://www.okgazette.com/oklahoma/article-15941-state-of-health.html

Finally, some recognition that healthy women make a healthy country

One of my favorite parts of the ACA is the recognition that women's healthcare is important.  After all, women are the ones bearing the babies, right?  We're the ones who carry the keys to the next generation, and our healthcare issues have often been sidelined.  Just think of the fact that anatomy is often taught from the drawings of a man's body and that men have prescription coverage for erectile dysfunction drugs while women can't even get coverage for hormonal contraceptive, which has been proven to have multiple medical uses including reducing endometriosis, preventing acne, preventing ovarian cysts (personal note:  when those things explode, you are in a world of pain -- I ended up passed out on my kitchen floor for awhile), etc.  As of August 1, 2012, more preventative care measures are being completely covered by insurance (as a hook to get you to take care of yourself and save us all from major down-the-line expenses) AND women's healthcare treatment like domestic violence counseling, birth control, HPV testing, HIV screening, well-women visits, and gestational diabetes screening, among others, will now be covered.  This is HUGE!  I urge you to educate yourselves about the new law and to spread the word.  Let's make a healthier America.

Website for Services Covered:  http://www.healthcare.gov/news/factsheets/2010/07/preventive-services-list.html#CoveredPreventiveServicesforWomenIncludingPregnantWomen

News Release:
(http://www.hhs.gov/news/press/2012pres/07/20120731a.html)
Health care law gives women control over their care, offers free preventive services to 47 million women

Forty-seven million women are getting greater control over their health care and access to eight new prevention-related health care services without paying more out of their own pocket beginning Aug. 1, 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today.


Previously some insurance companies did not cover these preventive services for women at all under their health plans, while some women had to pay deductibles or copays for the care they needed to stay healthy. The new rules in the health care law requiring coverage of these services take effect at the next renewal date – on or after Aug. 1, 2012—for most health insurance plans. For the first time ever, women will have access to even more life-saving preventive care free of charge.


According to a new HHS report also released today, approximately 47 million women are in health plans that must cover these new preventive services at no charge. Women, not insurance companies, can now make health decisions that will keep them healthy, catch potentially serious conditions at an earlier state, and protect them and their families from crushing medical bills.


“President Obama is moving our country forward by giving women control over their health care,” Secretary Sebelius said. “This law puts women and their doctors, not insurance companies or the government, in charge of health care decisions.”


The eight new prevention-related services are:
•Well-woman visits.
•Gestational diabetes screening that helps protect pregnant women from one of the most serious pregnancy-related diseases.
•Domestic and interpersonal violence screening and counseling.
•FDA-approved contraceptive methods, and contraceptive education and counseling.
•Breastfeeding support, supplies, and counseling.
•HPV DNA testing, for women 30 or older.
•Sexually transmitted infections counseling for sexually-active women.
•HIV screening and counseling for sexually-active women.


The health care law has already helped women in private plans and Medicare for the first time gain access to potentially life-saving tests and services, such as mammograms, cholesterol screenings, and flu shots without coinsurance or deductibles. Today’s announcement builds on these benefits, generally requiring insurance companies to offer, with no copay, additional vital screenings and tests to help keep women healthy throughout their lives.


These services are based on recommendations from the Institute of Medicine, which relied on independent physicians, nurses, scientists, and other experts as well as evidence-based research to develop its recommendations. These preventive services will be offered without cost sharing beginning today in all new health plans.


Group health plans and issuers that have maintained grandfathered status are not required to cover these services. In addition, certain nonprofit religious organizations, such as churches and schools, are not required to cover these services. The Obama administration will continue to work with all employers to give them the flexibility and resources they need to implement the health care law in a way that protects women’s health while making common-sense accommodations for values like religious liberty.


For women who are pregnant or nursing, the new preventive services include gestational diabetes screening as well as breast-feeding support, counseling and supplies. Health services already provided under the health care law include folic acid supplements for women who may become pregnant, Hepatitis B screening for pregnant women, and anemia screening for pregnant women.


Women Medicare beneficiaries may already receive such preventive services as annual wellness visits, mammograms, and bone mass measurement for those at risk of osteoporosis and diabetes screening. Approximately 24.7 million women with Medicare used at least one free preventive service in 2011, including the new annual wellness visit.


Because of the Affordable Care Act, secure, affordable coverage is becoming a reality for millions of American women and families. Men and children are also able to take advantage of preventive services at no extra charge under the health care law. These services include flu shots and other immunizations, screenings for cancers, high blood pressure and cholesterol, and depression.


To learn more about the health care services you may be eligible for at no extra charge under the Affordable Care Act, go to http://www.healthcare.gov/prevention


For information about the U.S. Department of Health and Human Services report on the number of adult and adolescent women eligible for the preventive services at no charge after Aug. 1, 2012, see http://aspe.hhs.gov/health/reports/2012/womensPreventiveServicesACA/ib.shtml

No nurses, no nurses

I'm in the process of developing a lecture on the financial effects of the Affordable Care Act and the related Supreme Court opinion.  While driving to work today, I heard Morning Edition's piece on the shortage of nurses that already exists and that is going to get worse as the ACA begins to take effect.  Because of the increased demand for primary and preventative care, there will be an increased demand for nurses as a cost-effective way to provide this treatment.  This demand will also increase as baby boomers age and need more health care.  Great --- we need more nurses, which means we can provide more jobs in our economy.  Well, it's not that easy.  There is a nursing professor shortage.  Because of factors such as nurses wanting to take care of patients instead of going to school for many years beyond their 2- or 4-year degree and the pay disparity between experienced nurses or nurses in managerial roles versus nurses in professorial roles, among other factors, there aren't many nurses attaining PhDs.  Without a PhD, a nurse may not teach at a university.  (The program cited that fewer than 1% of nurses have their PhDs, which means the pool of qualified professors is very small.)  So the easy response may be, well, just increase the class size until we get more . . .  not so easy because laws require a minimum ratio of faculty to students considering how hands-on nursing education is.  Adding more complexity, there is also a serious diversity issue:  the nursing occupation desperately needs more Hispanic, African-American, and male nurses.  (As a personal note, when my mom was dying of cancer, one of her all-time favorite nurses was a male nurse named Pierre from a francophone country in Africa -- he was large enough to turn her 6'1" frame, and he had an extremely soothing voice and speaking cadence.  Ahhh, Pierre.  My dad also especially liked Pierre because they could speak French to one another.  We need more Pierres!) 

So, now that we've recognized this problem, what are the potential solutions?  Well, essentially we need to create an environment where we have temporary instructional changes to feed the demand and to buy the market time to create more nursing PhDs.  In addition, we need to create an environment where achieving a nursing PhD is seen as a desirable goal and where research and instruction of nurses is promoted.  I think that will need to start in the nursing schools themselves.  I think that any medical campus also needs to do more promoting and advising of students towards nursing PhD programs.  Undergraduate universities also would do well to promote nursing PhD tracks and attempting to provider those who bail out of pre-med to consider nursing as an alternative.  Given the scarcity of the number of nursing educators, it seems likely that students just aren't aware of the possibility and what it could provide for them.  

This nursing shortage and nursing professor shortage is and will continue to have an impact on Americans.  Let's keep an eye on this and see what changes schools and nurses make in order to meet the needs.  

Listen to or read the NPR story here:  http://www.npr.org/blogs/health/2012/08/03/156213925/nursing-schools-brace-for-faculty-shortage

Refund on Health Insurance

So, when I was unemployed and when I was working at a small firm, I needed to buy my own health insurance.  Thus, after a very stressful search and application period, I ended up with Golden Rule, through United.  I can't really complain, it didn't charge me a whole lot, and it covered the basics (except for prescriptions, which did cause some issues).  Obviously, because I now work for a university, I am on its healthcare plan.  Well, last week I received a love letter from Golden Rule along with a check!  Because of the Affordable Care Act's provision that requires that if a health insurance company doesn't spend at least 80% of its collected premiums on health care services, then it must return the difference to the enrollees.  This is called the 80-20 rule, and it is meant to minimize administrative costs to only 20% of a company's expenses.  In 2011, Golden Rule in Tennessee spent only 70.9% of its total $35M in premiums on health care expenses, meaning that it missed the 80% mark by 9.1%.  Thus, Golden Rule was required to send its enrollees who paid during that period checks of 9.1% of their premiums paid.  Hurrah!  I received a check!  I am pleased to see the ACA working to increase efficiency and decrease administrative padding.  Thanks, Congress and President Obama.  I'm now going to go deposit my small yet morally and politically-pleasing check.  

Feisty on a Sunday

So this morning, I spent about 30-45 minutes picking up trash from around our neighborhood.  Beyond the general littering, our neighborhood, which includes a wonderful marsh full of wildlife, is plagued by construction debris.  I'd had it.  There were water bottles rolling around, cans smashed in the road, nails in the road, etc.  So, I decided to take action, and I've written a letter to Home Creations, the company that is building the houses.  I urge you to do the same:  identify a need that is in front of your face, and do something about it.  Whether it is picking up the trash or feeding some stray kittens (we're also doing this) or whatever you see.  Take action and then try to hold the person who or company that caused the situation responsible for the need created.

Here's my letter to Home Creations:

In addition, as promised, I've written my US Representative James Lankford about the waste at the House of Rep over trying to repeal the ACA for the 33rd time!  I cannot believe that Republicans can say with a straight face that they are for small government and for fiscal responsibility while they spin their wheels to the tune of $48M * 33 times to issue symbolic votes.  It is disgusting.  Once or twice, okay, but thirty-three times and especially with that cost and at a time when so Americans need real leadership . . .  it's a travesty.

Here's my letter to my representative, and I urge you to write yours:

p.s.  notice that I didn't point out that I'm a liberal . . .  I'm sure his interns will figure that out soon enough.  (Hello little interns!)

How the ACA is Helping People

Just got this press release from HHS about all the people that the ACA has been helping.  I'll try to publish some stats on how much annual wellness exams improve overall health and reduce health care costs for society, but for now,  you're just going to have to believe it.  In addition, while a copay of $5 sounds minimal to most of us (I'm thinking $5???  Mine's $25!), it is a significant amount of money to many Americans on Medicare and who need to go to the doctor often.  Remember that many people don't accrue savings for their retirement, or if they did, it's now gone, whether due to being too small or bad investing. 

Here's the announcement:

News Release

FOR IMMEDIATE RELEASE
July 10, 2012
Contact: HHS Press Office
(202) 690-6343

More than 16 million people with Medicare get free preventive services in 2012
Affordable Care Act made many preventive services no cost to beneficiaries

The Affordable Care Act – the new health care law – helped over 16 million people with original Medicare get at least one preventive service at no cost to them during the first six months of 2012, Health and Human Services (HHS) Secretary Kathleen Sebelius announced today. This includes 1.35 million who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act. In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.

“Millions of Americans are getting cancer screenings, mammograms and other preventive services for free thanks to the health care law,” said Secretary Sebelius. “These new benefits, made possible through the health care law, are helping people stay healthy by giving them the tools they need to prevent health problems before they happen.”

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits such as cancer screenings. Through the Affordable Care Act, preventive benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.

The law also added an important new service for people with Medicare — an Annual Wellness Visit with the doctor of their choice— at no cost to beneficiaries.

For more information on Medicare-covered preventive services, please visit: http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html

To learn what screenings, vaccinations and other preventive services doctors recommend for you and those you care about, please visit the myhealthfinder tool at www.healthfinder.gov.