Health insurers could exclude one in four Americans from coverage because they don't have bank accounts

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic

A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month’s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

“I think there is a dawning awareness that this is a large problem,” Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

“I’ve not seen any specific guidance that says you have to be able to accept these types of payments,” Ray Smithberger, Cigna’s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

“If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” Haile told Varney. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic

A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month’s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

“I think there is a dawning awareness that this is a large problem,” Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

“I’ve not seen any specific guidance that says you have to be able to accept these types of payments,” Ray Smithberger, Cigna’s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

“If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” Haile told Varney. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

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Fort Campbell works to address post-traumatic stress disorder, common ailment of Afghanistan-Iraq veterans

Research shows almost 14 percent of veterans returning home from Iraq and Afganistan suffer from post-traumatic stress disorder (PTSD), and as an estimated 2 million veterans are coming home, Fort Campbell has quickly acted by reaching out to the medical community in Kentucky to help address the challenges of PTSD.

Top behavioral health and brain injury research experts came to Ft. Campbell on Tuesday to teach civilian behavioral health professionals about the military's current PTSD and brain injury research and treatments, reports Kristin Hall of The Associated Press.

PTSD can be one of war's ugly side effect, and it is an anxiety disorder that can develop after exposure to a terrifying event in which ther's potential for grave physical harm, such as "violent personal assaults, natural or human-caused disasters, accidents, and military combat," says the National Institute of Mental Health. Not properly treating PTSD symptoms can lead to alcohol or drug use, spouse or child abuse, depression or suicide

The clinics at Ft. Campbell will focus on PTSD and brain trauma treatment and will each have 13 mental health professionals to offer more personalized, focused care, which is expected to reduce "cases of psychiatric problems, spouse or child abuse, sexually transmitted diseases, suicides and drug use," like the pilot program at Fort Carson in Colorado, reports Adam Ghassemi of News Channel 5.

Some Kentucky veterans, like Mike Jeffrey who spoke about his physical and mental battles after his two tours in Iraq at a Veteran's Recognition Program, are addressing other problems associated with PTSD, which are that many veterans won't talk about it, and they both families and veterans lack awareness about treatment options. Jeffrey talked about the struggles he had when returning home and his "baby steps" toward normalcy.

“I woke up and had kicked down my apartment doors overnight without knowing it,” he said. “It was hell just living with myself,” reported Tracy Harris of The News Democrat. Jeffrey started counseling for his PTSD and is now using a service dog trained specifically for veterans, Seal Team.

“Seal Team is his security blanket,” said Jeffrey's wife, Shelly, who contacted four service dog organizations before finding K-9 trainer Mike Halley, a Vietnam veteran living in Florida, reports Harris. In addition to suggesting use of a service dog, Jeffrey said veterans shouldn't bury their own experience with PTSD, which many are reluctant to talk about.

“We all grew up in the suck-it-up-and-drive Army,” he said. “But you can only suck it up for so long,” said Jeffrey.

Efforts like the ones made by Ft. Campbell and Mike Jeffrey represent progress in treatment of mental health issues. And while these efforts alone won't address the problem, work within local communities can make a world of difference for struggling veterans.

Retired Maj. Gen. Mark Graham said "there is no quick way to eliminate the stigma often attached to seeking out mental health care, but the key is partnerships with the communities," writes Hall.

The story of returning veteran's is a big one that may be hard to cover, so click here for journalism tips. Click here to learn more about PTSD programs in Kentucky, or click the link below to watch news coverage about the behavioral health clinics in Ft. Campbell.

Ft. Campbell Opens Behavioral Health Clinics To Fight PTSD - NewsChannel5.com | Nashville News, Weather & Sports

Research shows almost 14 percent of veterans returning home from Iraq and Afganistan suffer from post-traumatic stress disorder (PTSD), and as an estimated 2 million veterans are coming home, Fort Campbell has quickly acted by reaching out to the medical community in Kentucky to help address the challenges of PTSD.

Top behavioral health and brain injury research experts came to Ft. Campbell on Tuesday to teach civilian behavioral health professionals about the military's current PTSD and brain injury research and treatments, reports Kristin Hall of The Associated Press.

PTSD can be one of war's ugly side effect, and it is an anxiety disorder that can develop after exposure to a terrifying event in which ther's potential for grave physical harm, such as "violent personal assaults, natural or human-caused disasters, accidents, and military combat," says the National Institute of Mental Health. Not properly treating PTSD symptoms can lead to alcohol or drug use, spouse or child abuse, depression or suicide

The clinics at Ft. Campbell will focus on PTSD and brain trauma treatment and will each have 13 mental health professionals to offer more personalized, focused care, which is expected to reduce "cases of psychiatric problems, spouse or child abuse, sexually transmitted diseases, suicides and drug use," like the pilot program at Fort Carson in Colorado, reports Adam Ghassemi of News Channel 5.

Some Kentucky veterans, like Mike Jeffrey who spoke about his physical and mental battles after his two tours in Iraq at a Veteran's Recognition Program, are addressing other problems associated with PTSD, which are that many veterans won't talk about it, and they both families and veterans lack awareness about treatment options. Jeffrey talked about the struggles he had when returning home and his "baby steps" toward normalcy.

“I woke up and had kicked down my apartment doors overnight without knowing it,” he said. “It was hell just living with myself,” reported Tracy Harris of The News Democrat. Jeffrey started counseling for his PTSD and is now using a service dog trained specifically for veterans, Seal Team.

“Seal Team is his security blanket,” said Jeffrey's wife, Shelly, who contacted four service dog organizations before finding K-9 trainer Mike Halley, a Vietnam veteran living in Florida, reports Harris. In addition to suggesting use of a service dog, Jeffrey said veterans shouldn't bury their own experience with PTSD, which many are reluctant to talk about.

“We all grew up in the suck-it-up-and-drive Army,” he said. “But you can only suck it up for so long,” said Jeffrey.

Efforts like the ones made by Ft. Campbell and Mike Jeffrey represent progress in treatment of mental health issues. And while these efforts alone won't address the problem, work within local communities can make a world of difference for struggling veterans.

Retired Maj. Gen. Mark Graham said "there is no quick way to eliminate the stigma often attached to seeking out mental health care, but the key is partnerships with the communities," writes Hall.

The story of returning veteran's is a big one that may be hard to cover, so click here for journalism tips. Click here to learn more about PTSD programs in Kentucky, or click the link below to watch news coverage about the behavioral health clinics in Ft. Campbell.

Ft. Campbell Opens Behavioral Health Clinics To Fight PTSD - NewsChannel5.com | Nashville News, Weather & Sports

Read More

The CALCIUM MYTH and osteoporosis: America promotes the CAUSE as the CURE:

 

You hear it all the time; as  people age or become “seniors” that it is accepted in society to have brittle bones, get shorter, experience hip fractures, and/or have arthritis.  Then to make things worse, just about every magazine touts calcium supplements to help make bones strong.  This all happens in a country that eats meat and drinks milk like there’s no tomorrow. Americais one of the most dairy consuming nations in the world, yet we also have the highest statistics for osteoporosis, arthritis and other bone mass loss “disorders.”

 

Consider this; humans are the only animals who consume beyond infancy and we are the only ones that consume milk from another animal. Does this seem natural to you?

http://www.youtube.com/watch?v=zG_tn3KAXNE   “Foods that Kill”

 

THE CALCIUM DETOUR

 

Where has Americagone wrong?  We are being brainwashed and force fed calcium, and the wrong kind at that, right and left. By believing that we should be consuming dairy and eating lots of meat, red and white, our bodies are loaded with toxins and produce acid to break this down. In turn, calcium is actually leached from the bones to try to balance this awful imbalance,leading to calcium deficiency and fueling all the problems mentioned earlier.  In other words, even if we have the right kind of calcium in our body, it’s being drained by the body’s intense efforts to break down these ever popular animal fats and protein in order to compensate for bad eating habits.

 

CHEAP CALCIUM SUPPLEMENTS INCLUDE OYSTER SHELLS, CHALK AND ROCKS

http://www.uswellnessmeats.com/Calcium_Myth_and_Facts.pdf

 

Here comes the double whammy. On top of toxic meat and dairy, most Americans take calcium supplements, which further toxify the body, leaching the good calcium and adding to the health chaos.  Most people try to change their diet once they learn a little bit about what is causing their health issues. The problem is mainly based in where they obtain their information, especially regarding calcium supplements and critical minerals for absorption. Big pharma sells most of these as isolated components or sources, which nullifies the value.  Trace minerals work in tandem, so most generic vitamin supplements which contain minerals are isolated and reformulated to do the body harm. The Health Ranger, Mike Adams, is doing extensive research, for his Natural News store and other supplements he recommends. This helps the busy consumer find the best sources of calcium, magnesium, silica and other vital nutrients so they are not misled by hoaxes, seashells and rocks. The ultimate goal in dispelling the calcium myth is to promote longevity and anti-aging products instead of perpetuating the chronic American nightmare. 

 

To keep your blood from being acidic, eat less or no meat and dairy and turn to organic, raw vegetables and fruits for your natural calcium and magnesium. This will give you strong bones and a healthy heart. Natural news has more on this. Follow the Health Ranger and the Natural News tracker.  Health enthusiasts are on line breaking down the great calcium and protein myths. We invite you to please join!

http://naturalnewstracker.wordpress.com/2012/10/01/new-natural-news-store-mike-adams-providing-wide-varieties-of-superfoods-and-nutritional-supplements/

 

 

You hear it all the time; as  people age or become “seniors” that it is accepted in society to have brittle bones, get shorter, experience hip fractures, and/or have arthritis.  Then to make things worse, just about every magazine touts calcium supplements to help make bones strong.  This all happens in a country that eats meat and drinks milk like there’s no tomorrow. Americais one of the most dairy consuming nations in the world, yet we also have the highest statistics for osteoporosis, arthritis and other bone mass loss “disorders.”

 

Consider this; humans are the only animals who consume beyond infancy and we are the only ones that consume milk from another animal. Does this seem natural to you?

http://www.youtube.com/watch?v=zG_tn3KAXNE   “Foods that Kill”

 

THE CALCIUM DETOUR

 

Where has Americagone wrong?  We are being brainwashed and force fed calcium, and the wrong kind at that, right and left. By believing that we should be consuming dairy and eating lots of meat, red and white, our bodies are loaded with toxins and produce acid to break this down. In turn, calcium is actually leached from the bones to try to balance this awful imbalance,leading to calcium deficiency and fueling all the problems mentioned earlier.  In other words, even if we have the right kind of calcium in our body, it’s being drained by the body’s intense efforts to break down these ever popular animal fats and protein in order to compensate for bad eating habits.

 

CHEAP CALCIUM SUPPLEMENTS INCLUDE OYSTER SHELLS, CHALK AND ROCKS

http://www.uswellnessmeats.com/Calcium_Myth_and_Facts.pdf

 

Here comes the double whammy. On top of toxic meat and dairy, most Americans take calcium supplements, which further toxify the body, leaching the good calcium and adding to the health chaos.  Most people try to change their diet once they learn a little bit about what is causing their health issues. The problem is mainly based in where they obtain their information, especially regarding calcium supplements and critical minerals for absorption. Big pharma sells most of these as isolated components or sources, which nullifies the value.  Trace minerals work in tandem, so most generic vitamin supplements which contain minerals are isolated and reformulated to do the body harm. The Health Ranger, Mike Adams, is doing extensive research, for his Natural News store and other supplements he recommends. This helps the busy consumer find the best sources of calcium, magnesium, silica and other vital nutrients so they are not misled by hoaxes, seashells and rocks. The ultimate goal in dispelling the calcium myth is to promote longevity and anti-aging products instead of perpetuating the chronic American nightmare. 

 

To keep your blood from being acidic, eat less or no meat and dairy and turn to organic, raw vegetables and fruits for your natural calcium and magnesium. This will give you strong bones and a healthy heart. Natural news has more on this. Follow the Health Ranger and the Natural News tracker.  Health enthusiasts are on line breaking down the great calcium and protein myths. We invite you to please join!

http://naturalnewstracker.wordpress.com/2012/10/01/new-natural-news-store-mike-adams-providing-wide-varieties-of-superfoods-and-nutritional-supplements/

 

Read More

Ky. is already short of doctors, dentists; how will its health-care system handle expansion of Medicaid and private insurance?

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

Read More

How do viruses infect cells?

Hu B, Margolin W, Molineux IJ and Liu J. The Bacteriophage T7 Virion Undergoes Extensive Structural Remodeling During Infection. Science. 2013; 339: 576-9.

Winn Feline Foundation has long been involved in funding research that studies how particular viruses infect cells. One example is the study from 2008 led by Dr. H. F. Egberink of the University of Utrecht in the Netherlands titled “ Identification of the cellular receptor for feline coronaviruses” (W08-006).
 

Researchers continue to learn more about how viruses infect cells or attach to cells to destroy them. Viruses that can destroy certain bacteria are called bacteriophages. It is known that a bacteriophage’s ability to take up and hold liquid on the surface of a solid along with ejection of their genome are important to their life cycle, yet their molecular mechanisms are not well understood.

In this study from the University of Texas, the authors used special electronic imaging (cryoelectron tomography) to capture T7 virions at successive stages of infection of the bacteria, Escherichia coli, minicells at ~4-nm resolution. Six tail fibers were folded against the central capsid, extending and orienting only after attaching and holding to the host cell surface. Receptor binding by the tail results in the insertion of an extended tail, which functions as the DNA ejection mechanism into the cell cytoplasm. After the DNA ejection, the extended tail collapses or dissembles, which allowed resealing of the infected cell membrane. [VT]

Related blog articles:
Understanding FIP virulence (October 2012)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

Hu B, Margolin W, Molineux IJ and Liu J. The Bacteriophage T7 Virion Undergoes Extensive Structural Remodeling During Infection. Science. 2013; 339: 576-9.

Winn Feline Foundation has long been involved in funding research that studies how particular viruses infect cells. One example is the study from 2008 led by Dr. H. F. Egberink of the University of Utrecht in the Netherlands titled “ Identification of the cellular receptor for feline coronaviruses” (W08-006).
 

Researchers continue to learn more about how viruses infect cells or attach to cells to destroy them. Viruses that can destroy certain bacteria are called bacteriophages. It is known that a bacteriophage’s ability to take up and hold liquid on the surface of a solid along with ejection of their genome are important to their life cycle, yet their molecular mechanisms are not well understood.

In this study from the University of Texas, the authors used special electronic imaging (cryoelectron tomography) to capture T7 virions at successive stages of infection of the bacteria, Escherichia coli, minicells at ~4-nm resolution. Six tail fibers were folded against the central capsid, extending and orienting only after attaching and holding to the host cell surface. Receptor binding by the tail results in the insertion of an extended tail, which functions as the DNA ejection mechanism into the cell cytoplasm. After the DNA ejection, the extended tail collapses or dissembles, which allowed resealing of the infected cell membrane. [VT]

Related blog articles:
Understanding FIP virulence (October 2012)

More on cat health:
Winn Feline Foundation Library
Find us on Facebook
Follow us on Twitter
Join us on Google+

Read More

Don't get burned, bitten or bamboozled this summer; here are safety tips for dealing with the sun, insects and sales pitches

By Molly Burchett
Kentucky Health News

Summer is finally here, and after one of the coldest Kentucky springs, who doesn't want to be outside swimming, skiing, fishing, barbecuing or soaking up rays on the beach? While summer may bring much-anticipated fun in the sun, it's important to take some  safety precautions to make sure you and your family are not getting too much of a good thing.

Sunscreen can protect you from cancer, but don't spray it

The sun is bad for your skin, and exposure to its harmful ultraviolet (UV) rays can increase your risk for skin cancer, which is the most common cancer in the U.S., says the federal Centers for Disease Control and Prevention. It's critical to protect yourself and your children from sun damage because just one blistering sunburn in childhood more than doubles the odds of developing skin cancer later in life, says the Mayo Clinic.

Fortunately, it’s never too late or too early to lessen your risk of sun damage by using sunscreen, and the Environmental Working Group has recently released its 2013 Guide to Sunscreens, which rates more than 1,400 sunscreens, lip balms, and SPF moisturizers and cosmetics for safety and effectiveness.

This year, EWG says 184 sunscreens, 25 percent of those on the market, met its criteria of offering adequate UV protection and posing few safety concerns. You can click here to view that product list, or here to check out the EWG findings for moisturizers, lip balm and makeup.

EWG also created a somewhat surprising list of things NOT to bring on vacation because they are unsafe or do not provide adequate UV protection:

• Spray sunscreen: These sprays may pose serious inhalation risks, and they make it too easy to not apply enough sunscreen or to miss a spot.
• High-SPF sunscreens: These products may tempt people to stay in the sun too long, which can increase the risk of other kinds of skin damage, and EWG recommends that consumers avoid products labeled higher than SPF 50.
• Oxybenzone: Used in half of sunscreen products, this chemical penetrates the skin and can adversely impact health in several ways; in the body, it acts like the female hormone estrogen and can cause allregic reactions.
• Loose powder sunscreen: Tiny zinc particles in these products can also end up in your lungs when you breathe them in during application, which irritates the lungs.
• Retinyl palmitate: Some sunscreens contain this chemical, which is a form of vitamin A, but when applied to sun-exposed skin, it may speed development of skin tumors and lesions.
• Combined sunscreen/bug repellents: Studies show this combination leads to increased skin absorption of the repellent ingredients.
• Sunscreen towelettes: Whether they really work is unknown.
• Tanning oils: They are simply a bad idea and can ultimately lead to behavior that increases risk of developing skin cancer.

So, check the ingredients for your sunscreen, avoid high-SPF's or sprays and make it a habit to wear sunscreen during sports or whenever you're outside. Be sure to reapply often to ensure UV protection, particularly if you get wet or sweaty. Click here to read EWG's "Nine Surprising Facts about Sunscreen."

Hats and clothing: Choose the right kind

Children are more vulnerable to sun damage, so in addition to actual sunscreen, the best sun protections for them are a hat and shirt (which also protect adults). The CDC recommends avoiding straw hats that let sun through the holes, and to wear a hat with UV protection or a wide brim to shield the face, head, ear and neck. If you do chose to wear a baseball cap, protect your ears and neck with clothing, sunscreen (with at least SPF 15) or spend lots of time in shade.

Wear clothing to protect exposed skin. The CDC says loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best UV protection. Darker colors may offer more protection than lighter colors, and a wet t-shirt offers much less UV protection that a dry one.

Sunburn treatment: People with fair skin or light-colored hair are more likely to be sunburned. If you get sunburned, remember that "The skin heals but is forever damaged," writes University of Kentucky nursing Professor Mollie Aheshire. "The more frequent and more severe the burns, the more damage there is," along with risk for cancer and premature aging. "If a sunburn is blistering and covers a large portion of your body; is accompanied by a high fever, extreme pain, confusion, nausea or chills; or does not respond to at-home treatment within a few days . . . see a health-care provider." Mild sunburns can be treated with over-the-counter pain relievers, cold compresses and moisturizing creams — aloe vera or hydrocortisone lotions. "If blisters form, do not break them," Aheshire writes. "Drink plenty of fluids to prevent dehydration. Treat peeling skin gently. Stay out of the sun until redness and pain resolve." (Read more)

Sunglasses: Not just to help you see now, but to keep you seeing longer

Besides being dangerous for your skin, UV rays are dangerous to your eyes and can cause vision disorders, premature aging of the eyes or even blindness. It is important to wear sunglasses to protect eyes from sun damage, although a new survey from the American Optometric Association shows that only 40 percent of consumers cite this protection as the primary reason for wearing sunglasses, says a Kentucky Optometric Association press release.

To help reduce the risks of harmful UV exposure on the eyes, children and adults should start wearing protective sunglasses as as early as possible, and parents should ensure that babies are protected by sunglasses too, says the release. When choosing sunglasses or protective contact lenses, make sure that they block more than 95 percent of UV-A and more than 99 percent of UV-B radiation, says the KOA, and sunglasses should have a frame that fits close to the eyes so the UV rays can't sneak around the sides.

Insect repellent: Bugs can bug you, but don't over-react to them

Although nothing can ruin a relaxing summer picnic faster than bugs, take precautions to ensure you're using the right type of bug repellent-- one that's been approved by the Environmental Protection Agency -- and that you're using it wisely.

Not only are bugs annoying, they can also carry dangerous diseases, and for the safe and effective use bug repellents, always read the product label before using the product, EPA says. It says to follow these bug-repellent safety tips:

• Repellents should be applied only to exposed skin and/or clothing. Do not use them under clothing.
• Store insect repellents safely out of the reach of children.
• Do not apply near eyes and mouth, and be use sparingly around the ears.
• When using sprays, spray on the hands first and then apply to the face, not directly to the face.
• Never use repellents over cuts, wounds or irritated skin.
• Do not spray in enclosed areas and avoid spraying near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals
• Most insect repellents do not work on lice or fleas. 
• Click here to search for a repellent that's right for you.

Beware if you want to use a wearable repellent that's not sticky and has to be continuously resprayed, such as Off!'s clip-on mosquito repellent. It works once the cloud of mosquito protection is built around the wearer, says Brighid Moret of The Washington Times, but it's not a good option for an active or young child. The manufacturer warns on the label that a chemical on the product's enclosed disk is harmful if swallowed, directly inhaled or absorbed through the skin, and young children should not wear it.

Whether you're going on vacation or a "stay-cation," these tips can help protect you and your family from the sun and bugs in order to safely make the most of your summer. Click here for more sun safety tips from EWG.

By Molly Burchett
Kentucky Health News

Summer is finally here, and after one of the coldest Kentucky springs, who doesn't want to be outside swimming, skiing, fishing, barbecuing or soaking up rays on the beach? While summer may bring much-anticipated fun in the sun, it's important to take some  safety precautions to make sure you and your family are not getting too much of a good thing.

Sunscreen can protect you from cancer, but don't spray it

The sun is bad for your skin, and exposure to its harmful ultraviolet (UV) rays can increase your risk for skin cancer, which is the most common cancer in the U.S., says the federal Centers for Disease Control and Prevention. It's critical to protect yourself and your children from sun damage because just one blistering sunburn in childhood more than doubles the odds of developing skin cancer later in life, says the Mayo Clinic.

Fortunately, it’s never too late or too early to lessen your risk of sun damage by using sunscreen, and the Environmental Working Group has recently released its 2013 Guide to Sunscreens, which rates more than 1,400 sunscreens, lip balms, and SPF moisturizers and cosmetics for safety and effectiveness.

This year, EWG says 184 sunscreens, 25 percent of those on the market, met its criteria of offering adequate UV protection and posing few safety concerns. You can click here to view that product list, or here to check out the EWG findings for moisturizers, lip balm and makeup.

EWG also created a somewhat surprising list of things NOT to bring on vacation because they are unsafe or do not provide adequate UV protection:

• Spray sunscreen: These sprays may pose serious inhalation risks, and they make it too easy to not apply enough sunscreen or to miss a spot.
• High-SPF sunscreens: These products may tempt people to stay in the sun too long, which can increase the risk of other kinds of skin damage, and EWG recommends that consumers avoid products labeled higher than SPF 50.
• Oxybenzone: Used in half of sunscreen products, this chemical penetrates the skin and can adversely impact health in several ways; in the body, it acts like the female hormone estrogen and can cause allregic reactions.
• Loose powder sunscreen: Tiny zinc particles in these products can also end up in your lungs when you breathe them in during application, which irritates the lungs.
• Retinyl palmitate: Some sunscreens contain this chemical, which is a form of vitamin A, but when applied to sun-exposed skin, it may speed development of skin tumors and lesions.
• Combined sunscreen/bug repellents: Studies show this combination leads to increased skin absorption of the repellent ingredients.
• Sunscreen towelettes: Whether they really work is unknown.
• Tanning oils: They are simply a bad idea and can ultimately lead to behavior that increases risk of developing skin cancer.

So, check the ingredients for your sunscreen, avoid high-SPF's or sprays and make it a habit to wear sunscreen during sports or whenever you're outside. Be sure to reapply often to ensure UV protection, particularly if you get wet or sweaty. Click here to read EWG's "Nine Surprising Facts about Sunscreen."

Hats and clothing: Choose the right kind

Children are more vulnerable to sun damage, so in addition to actual sunscreen, the best sun protections for them are a hat and shirt (which also protect adults). The CDC recommends avoiding straw hats that let sun through the holes, and to wear a hat with UV protection or a wide brim to shield the face, head, ear and neck. If you do chose to wear a baseball cap, protect your ears and neck with clothing, sunscreen (with at least SPF 15) or spend lots of time in shade.

Wear clothing to protect exposed skin. The CDC says loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best UV protection. Darker colors may offer more protection than lighter colors, and a wet t-shirt offers much less UV protection that a dry one.

Sunburn treatment: People with fair skin or light-colored hair are more likely to be sunburned. If you get sunburned, remember that "The skin heals but is forever damaged," writes University of Kentucky nursing Professor Mollie Aheshire. "The more frequent and more severe the burns, the more damage there is," along with risk for cancer and premature aging. "If a sunburn is blistering and covers a large portion of your body; is accompanied by a high fever, extreme pain, confusion, nausea or chills; or does not respond to at-home treatment within a few days . . . see a health-care provider." Mild sunburns can be treated with over-the-counter pain relievers, cold compresses and moisturizing creams — aloe vera or hydrocortisone lotions. "If blisters form, do not break them," Aheshire writes. "Drink plenty of fluids to prevent dehydration. Treat peeling skin gently. Stay out of the sun until redness and pain resolve." (Read more)

Sunglasses: Not just to help you see now, but to keep you seeing longer

Besides being dangerous for your skin, UV rays are dangerous to your eyes and can cause vision disorders, premature aging of the eyes or even blindness. It is important to wear sunglasses to protect eyes from sun damage, although a new survey from the American Optometric Association shows that only 40 percent of consumers cite this protection as the primary reason for wearing sunglasses, says a Kentucky Optometric Association press release.

To help reduce the risks of harmful UV exposure on the eyes, children and adults should start wearing protective sunglasses as as early as possible, and parents should ensure that babies are protected by sunglasses too, says the release. When choosing sunglasses or protective contact lenses, make sure that they block more than 95 percent of UV-A and more than 99 percent of UV-B radiation, says the KOA, and sunglasses should have a frame that fits close to the eyes so the UV rays can't sneak around the sides.

Insect repellent: Bugs can bug you, but don't over-react to them

Although nothing can ruin a relaxing summer picnic faster than bugs, take precautions to ensure you're using the right type of bug repellent-- one that's been approved by the Environmental Protection Agency -- and that you're using it wisely.

Not only are bugs annoying, they can also carry dangerous diseases, and for the safe and effective use bug repellents, always read the product label before using the product, EPA says. It says to follow these bug-repellent safety tips:

• Repellents should be applied only to exposed skin and/or clothing. Do not use them under clothing.
• Store insect repellents safely out of the reach of children.
• Do not apply near eyes and mouth, and be use sparingly around the ears.
• When using sprays, spray on the hands first and then apply to the face, not directly to the face.
• Never use repellents over cuts, wounds or irritated skin.
• Do not spray in enclosed areas and avoid spraying near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals
• Most insect repellents do not work on lice or fleas. 
• Click here to search for a repellent that's right for you.

Beware if you want to use a wearable repellent that's not sticky and has to be continuously resprayed, such as Off!'s clip-on mosquito repellent. It works once the cloud of mosquito protection is built around the wearer, says Brighid Moret of The Washington Times, but it's not a good option for an active or young child. The manufacturer warns on the label that a chemical on the product's enclosed disk is harmful if swallowed, directly inhaled or absorbed through the skin, and young children should not wear it.

Whether you're going on vacation or a "stay-cation," these tips can help protect you and your family from the sun and bugs in order to safely make the most of your summer. Click here for more sun safety tips from EWG.

Read More