Friday, March 18, 2011

Health - Patient Money: New Health Plans for People With Pre-existing Conditions

Health - Patient Money: New Health Plans for People With Pre-existing Conditions

Patient Money: New Health Plans for People With Pre-existing Conditions

Posted: 18 Mar 2011 10:22 AM PDT

SIX years ago, Jerry Garner, 45, a real estate agent in Gowen, Mich., underwent a kidney transplant. He recovered nicely, and thanks to diligent adherence to his drug regimen and frequent checkups, he has been healthy ever since — “a miracle,” said his wife, Stephanie.

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Fabrizio Costantini for The New York Times

Jerry Garner, here with his wife, Stephanie, lost his health insurance when the couple mistakenly neglected to fill out a health survey the insurer sent.

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But last year, the Garners were starting to believe that their good fortune had run out.

Mr. Garner’s insurer asked that he fill out a survey, but somehow this piece of mail slipped through the cracks at the Garner household. As a result, he lost his health insurance.

(Ms. Garner, 44, and three of the children — their oldest child is grown — were covered under a different policy.) But because of his pre-existing condition, Mr. Garner proved impossible to insure.

Transplant recipients must take expensive immunosuppressant medications. Without them, the new kidney will not survive. The couple paid Mr. Garner’s $2,000 monthly drug bill out of pocket and prayed nothing went wrong. Some months they had to choose between the medication and the mortgage.

Finally, after weeks of searching the Internet, making phone calls and praying, Ms. Garner saw a television ad for Michigan’s new pre-existing condition insurance plan. P.C.I.P.’s, as they are known, are state and federal programs for people previously deemed uninsurable because of pre-existing conditions. They offer a bridge to 2014, when the new health insurance exchanges, which must accept all comers, are to open.

Mr. Garner applied to Michigan’s plan and was accepted. Now he pays less in premiums than he did under his previous plan, and he receives more comprehensive coverage.

“It was definitely an answered prayer,” said Ms. Garner. “Two thousand dollars when you’re already struggling is just impossible.”

Plenty of people with pre-existing conditions like Mr. Garner are struggling to find affordable insurance. These plans offer a real alternative, but consumers are only now becoming aware of them. Plus, there are some tough restrictions. Here is what you need to know:

FINDING A PLAN Pre-existing condition insurance plans, required by the new health care law, opened for business in July. The new plans come in two flavors: 27 states run their own plans with federal money, while the rest rely on the federal Department of Health and Human Services to administer the plans within their borders.

The new plans did not replace state high-risk pools, which have long offered insurance to people with pre-existing conditions. But the premiums in the new plans are generally much lower. That is why experts had worried that the new plans could be overwhelmed by a deluge of desperate applicants.

In fact, the P.C.I.P.’s got off to a slow start, and many consumers still have no idea they exist. In January, premiums in the federally run plans were reduced nearly 20 percent. Since then, enrollment in all of the new plans has increased 50 percent to 12,000 members.

To find a plan in your state, start with the federal government’s Web site, PCIP.gov, which offers lots of application information and details about each of the state plans the department administers. An interactive map links to each federal- and state-run plan.

Next, you will need to compare the plan offerings in your state. Federally run P.C.I.P.’s offer three options: standard coverage; extended coverage, with a lower deductible and higher premiums; and an option that combines a high deductible with a health savings account. For a side-by-side comparison of the three choices, click on bit.ly/gs3z9i. Premiums for all three options are also listed online.

State plans that are not administered by the federal government may also offer more than one option. The details can be found at the interactive state map mentioned above.

People without access to the Internet can call the Department of Health and Human Services at 866-717-5826 to find out which plans are available in their states.

ELIGIBILITY RESTRICTIONS The plans were not intended to solve the health insurance mess. They were intended as a temporary Band-aid, and they have some frustrating limitations.

You must be uninsured for at least six months to be eligible for a plan. That means people already enrolled in state high-risk pools or private insurance cannot apply, even if the new plans would be far less expensive. Unemployed people who are on Cobra or whose benefits have only recently expired are also not eligible.

Plans run by the federal government and those administered by individual states have slightly different application procedures.

To qualify for a federally run plan, you will need proof that you have applied for individual insurance and that a carrier denied you coverage because of a pre-existing condition, or proof that a carrier approved coverage but with a rider that excluded payment for your pre-existing condition. (Do not buy a policy with such a rider, as you will no longer be eligible for a P.C.I.P.)

An uninsured patient may have to apply for insurance simply to get proof of denial to enroll in a plan. Proof may take the form of a denial letter.

State-run plans may have less stringent eligibility requirements. Some require proof of denial, but in others people with certain pre-existing conditions, like diabetes or asthma, qualify for coverage more or less automatically. Those people need only obtain a letter from their doctors or other health care providers confirming that they have one of the conditions recognized by the plan.

Patients who live in Vermont and Massachusetts can qualify for those state plans if they can show proof that the premiums they have been offered by a private insurer in the individual market are at least twice as high as the P.C.I.P. premium. But they cannot be enrolled in those plans.

If you are newly uninsured, have a pre-existing condition and are shopping for private insurance in the individual market, keep a record of any denials you may receive. If you do not find insurance on your own and you live in a state that requires denial confirmation, you will have the documentation you need.

THE RIGHT COVERAGE The federal government set aside $5 billion to subsidize the new plans. Even with the subsidies, an individual premium in the federally run standard plan for a 50-year-old can range from $320 to $570.

State-run plans determine their own premiums based on what the private insurance market charges insurable members. In Connecticut, for example, monthly premiums for the plan can be as much as $890.

Review your coverage options carefully. In the plans sponsored by the federal government, all three options cover 100 percent of preventive care, like annual physicals and screenings. All charge a 20 percent co-pay (40 percent for out-of-network providers) for other care, with a $5,950 out-of-pocket annual maximum for in-network care ($7,000 for out of network).

The difference is in the deductible. The standard plan has a $2,000 deductible for in-network care ($3,000 for out of network), compared to the extended plan’s $1,000 and $1,500 deductibles.

In Massachusetts, for example, standard plan premiums for people ages 35 to 44 are $324 a month, compared to $438 a month for the extended plan. If you can afford the higher out-of-pocket costs, it may make sense to opt for lower premiums.

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For Radiation, the Alarm Bells Are Boxes

Posted: 17 Mar 2011 09:16 PM PDT

ANAHEIM, Calif. — The radiation monitor works unobtrusively here on a tiny strip of fenced-off land just behind a schoolyard on a dead-end street. The machine that regularly sniffs the air, measuring whether radioactive fallout from Japan has reached Southern California, is a gray box, about three feet high and two feet wide.

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Monica Almeida/The New York Times

A radiation monitor in Anaheim, one of about a dozen in California and about 100 nationwide that feed data to the E.P.A.

The most remarkable thing is how unremarkable it is. A few other machines are perched atop black metal grates, constantly measuring the air pollution that is a fact of life here. The black dots on the filter are a reminder that the Southern California air is never quite pure.

While officials have taken care to reassure residents that the plume of irradiated air from Japan headed this way is not likely to be strong enough to prove harmful, the invisible threat is impossible to ignore. And it falls to scientists watching over similar operations up and down the West Coast to provide the first alarm bell.

A round, white patch on the radiation monitor collects the air throughout the day, sending hourly reports to officials throughout the country. The measurements are displayed in a dizzying array of numbers on a screen, but most days nobody stands in the sun to watch it. Instead, machines hum along on their own while scientists analyze the measurements from miles away.

“It used to be that this kind of situation would mean that someone had to come out here every few minutes to measure with a sample kit, now this goes basically on its own,” said Philip Fine, the atmospheric measurements manager with Southern California Air Quality Management District, which oversees three radiation monitors in the area. As he spoke, his voice was drowned out by the shouts of children on a nearby playground.

Although officials have repeatedly said that there is there is little reason for concern, the state health department has operated a telephone hot line for the last several days and has received hundreds of calls each day from people worried about radiation.

On Thursday, state officials said that no significant increases in radiation levels were expected on the West Coast. They also repeatedly cautioned people against taking potassium iodide — which can protect the thyroid gland from radiation exposure — because they said it does not work preventively and could cause negative side effects.

“I think the biggest health impact is the psychological impact,” said Dr. Jonathan E. Fielding, the director of the Los Angeles County Department of Public Health. “Anytime people hear ‘radiation’ it evokes a level of fear that is disproportionate to the threat.”

Dr. Fine similarly seemed to be taking the threat in stride, emphasizing that the machine — known as a Radnet monitor — can be remarkably sensitive to its immediate surroundings. So if, for example, a person who just went through radiation treatment walked by and sneezes, a spike in radiation would be detected. But if several machines scattered across the region showed a similar spike, it would draw scrutiny from officials, Dr. Fine said.

There are more than 100 such monitors throughout the United States, without about a dozen in California. Each feeds data to the Environmental Protection Agency, which has a lab in Alabama to analyze the numbers.

Dr. Fine and other analysts will spend much of the day Friday monitoring whether there has been any significant change in radiation overnight and then work with public health officials to determine possible risks.

“We wouldn’t want to send anyone into a panic because of a blip,” he said. “The numbers don’t mean anything until someone does a lot of calculations to determine if there is a concern.”

Ian Lovett contributed reporting from Los Angeles

Chernobyl Study Says Health Risks Linger

Posted: 18 Mar 2011 12:40 AM PDT

Nearly 25 years after the accident at the Chernobyl nuclear power plant in Ukraine, children and teenagers who drank contaminated milk or ate affected cheese in the days and weeks after the explosion still suffer from an increased risk of thyroid cancer, according to a study released Thursday by the National Cancer Institute.

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Kyodo News, via Associated Press

Checking for a radiation exposure level this week in Fukushima Prefecture.

The study confirms earlier research about the risks of radioactive iodine, which can accumulate in the thyroid gland and lead to cancer later. Potassium iodide is often given as a supplement to prevent the accumulation of the radioactive type in thyroid glands, but Russian authorities failed to provide the supplement to all those at risk.

Radioactive iodine has a half-life of just eight days, and it was not thought to be present outside the power plant in concentrations high enough to cause immediate health problems. But the isotope was concentrated by cows in milk, and children who drank contaminated milk or ate affected dairy products are particularly at risk.

An international team of researchers led by the National Cancer Institute, a federal agency based in Bethesda, Md., has been monitoring the health effects of the Chernobyl accident for years. In the study released Thursday, the team screened 12,500 people who were under 18-years-old at the time of the 1986 accident and lived in one of three provinces near the accident site. The subjects’ thyroid glands were measured for radioactivity within two months of the accident.

Those with the greatest exposures were at highest risk for developing thyroid cancer in later years, the researchers found. Sixty-five of the study’s subjects developed thyroid cancer during the study’s 10 years of screening.

Indeed, the increased risks associated with exposures to radioactive iodine have yet to show any sign of declining. Studies done in Japan after World War II suggested that the increased risks of thyroid cancer began to decline 30 years after the atomic explosions but remained above normal even 40 years later.

Some of the participants in the Chernobyl study lived as far as 90 miles from the accident site, demonstrating the risks of eating or drinking contaminated foods among people who were exposed to little or no radioactive iodine from the immediate fallout.

“This study confirms the risk of thyroid cancer from radioactive iodine,” Dr. Alina V. Brenner, a radiation epidemiologist at the cancer institute and a co-author of the study, said in an interview. “But thyroid cancer is largely a nonlethal cancer. If detected and treated in a timely manner, they have a good prognosis.”

That this study was released in the midst of the crisis at the stricken Fukushima Daiichi Nuclear Power Station in Japan was a coincidence. Indeed, government officials scheduled the release for Thursday because they feared weeks ago that the government might shut down on Friday as a result of a budget impasse on Capitol Hill.

Panel Urges F.D.A. to Review Menthol in Cigarettes

Posted: 18 Mar 2011 12:01 PM PDT

A federal advisory panel on Friday said removing menthol cigarettes from the market would benefit public health in the United States but did not make any specific recommendation for action by the Food and Drug Administration.

The F.D.A will review the findings of its Tobacco Products Scientific Advisory Committee and perform its own research and policy study, Lawrence R. Deyton, director of the F.D.A. Center for Tobacco Products, said Friday after the advisory group wrapped up a year of study.

The advisory panel’s chairman, Dr. Jonathan M. Samet, a professor of medicine at the University of Southern California, said the committee had found a scientific basis for the added harm caused by menthol in cigarettes, a decision that could provide a legal basis for the F.D.A. to try to limit, phase out or even ban menthol in cigarettes.

The F.D.A., given the authority to regulate the contents of cigarettes by a 2009 law, will make a progress report in about 90 days, Dr. Deyton said. “Now it’s up to us to do our job,” he said.

Industry analysts said they believed the F.D.A. might take a moderate final action.

Any action, however, would pose a host of extremely difficult social and political issues and face a protracted legal challenge by the tobacco industry, which said a ban would have no public health benefit and open up a criminal black market.

Menthol accounts for an estimated 27 percent of the $80 billion cigarette market in the United States and 19 million smokers — a disproportionate number of whom are African-Americans, younger and lower income. Menthol is preferred by more than 80 percent of black smokers, about 22 percent of white smokers, and nearly half of 12- to 17-year-old smokers.

The panel, in recommendations made public on Friday morning, said evidence showed that menthol led to more youth smoking, made it easier to start smoking and harder to quit.

“Menthol cigarettes have an adverse impact on the public health in the United States,” Dr. Mark Stuart Clanton, chief medical officer of the American Cancer Society, High Plains Division, in Austin, Tex., said in summarizing the scientific findings.

The public health finding is the strongest statement yet by any government group in the world involving menthol flavors.

Congress had banned candy, fruit and spice flavorants in tobacco but deferred the politically difficult issue of menthol to the F.D.A.

Under the law, the panel was required to consider the impact of menthol on public health and the likelihood it made it easier to start or harder to quit smoking.

Matthew L. Myers, president of the Campaign for Tobacco -Free Kids, said, “They’ve shown menthol increases youth usage significantly, which is a trigger for action.”

Any government action would be preceded by a proposed rule and another round of public comments and no doubt, lawsuits. Two tobacco companies filed a lawsuit last month to try to block the advisory committee action or force the F.D.A. to disregard its advice, saying panel members were biased and had financial conflicts of interest from legal and consulting work against tobacco companies, a claim the F.D.A. denied.

Lorillard Tobacco of Greensboro, N.C., which is more than 90 percent reliant on revenue from menthol products and makes the top brand, Newport, is leading the opposition to F.D.A. action and one of its scientists is a nonvoting member of the F.D.A. panel. Jonathan Daniel Heck, Lorillard’s principal scientist, issued the industry view Thursday saying there was no evidence that menthol promoted youth smoking or made it harder to quit.

Menthol provides a cooling sensation that masks the harsh taste of tobacco. Menthol levels have been manipulated to be lower for starter products like Newport, according to findings of the panel based partly on industry documents. Industry research shows younger smokers prefer some but not too much menthol.

Dr. Dorothy K. Hatsukami, a panel member and professor from the Tobacco Use Research Center at the University of Minnesota, said scientific literatures showed smokers who started younger were more likely to have trouble quitting and to die from smoking. “This is the population that’s particularly vulnerable to the effects of menthol cigarette smoking,” Dr. Hatsukami said.

Menthol has also been advertised over the years for claimed health benefits and it has been heavily advertised in African-American communities and magazines. Dr. Melanie Wakefield, an advisory panel member and director of an Australian research center, said menthol cigarettes continued to be marketed with images including the color green that falsely suggested they were healthier.

But Lorillard said the smoking rate of African-American youth was half that of white youth. The company also says there was “no difference in quit-smoking rates between menthol and non-menthol smokers.” Dr. Heck of Lorillard dismissed the false marketing claims as artifacts of decades past — although Dr. Wakefield said their effect persists.

More broadly, health groups say the menthol issue poses the first real test of the advisory committee and F.D.A. toughness against cigarettes. The recommendation may signal a willingness to crack down on nicotine, the addictive ingredient in tobacco products. Levels of nicotine, like menthol, have been manipulated by companies to fulfill marketing aims.

The law allows the F.D.A. to regulate tobacco product ingredients but not to ban cigarettes or nicotine entirely.

Vital Signs: Diet: Eating Fish Found to Ward Off Eye Disease

Posted: 18 Mar 2011 09:20 AM PDT

A new study reports yet another good reason to eat fish: women whose diet was rich in omega-3 fatty acids found in fish were at significantly lower risk of developing age-related macular degeneration.

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The Harvard Women’s Health Study, which followed 39,876 women in midlife, had participants fill out detailed food-frequency questionnaires at the start of the study in 1993. After an average 10 years of follow-up, 235 of the women had developed macular degeneration, a progressive eye disease that is the leading cause of irreversible vision loss in the elderly.

But the analysis, in Archives of Ophthalmology, found that women who had reported eating one or more servings of fish per week were 42 percent less likely to develop age-related macular degeneration than those who ate less than a serving each month. (Researchers adjusted the data to control for other factors linked to the disease, including smoking.) Eating canned tuna and dark-meat fish like mackerel, salmon, sardines, bluefish and swordfish appeared to have the most benefit.

“We know that inflammatory processes are involved in A.M.D., and the omega-3 long-chain fatty acids do have an anti-inflammatory effect,” said the lead author, Dr. William G. Christen, an associate professor at Brigham and Women’s Hospital and Harvard Medical School.

Vital Signs: Risks: Pain Drugs May Lead to Birth Defects

Posted: 18 Mar 2011 02:06 AM PDT

Women who take codeine, oxycodone and other opioid pain drugs early in pregnancy may be exposing their babies to a higher risk of birth defects, a new government study suggests.

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Though the overall numbers were small, babies whose mothers took opioids were considerably more likely than others to have congenital problems, including a potentially fatal syndrome in which the left part of the heart does not develop completely; spina bifida, in which the backbone and spinal canal do not close; and gastroschisis, in which the intestines stick out of the body.

The study, from the Centers for Disease Control and Prevention, was one of the largest to examine the effects of opioid use during pregnancy. It appeared last month in The American Journal of Obstetrics & Gynecology.

It used data from the National Birth Defects Prevention Study about mothers in 10 states who gave birth from 1997 to 2005. Information was drawn from hourlong computer-assisted telephone interviews with the mothers.

Of 17,449 mothers whose babies had a birth defect, 454, or 2.6 percent, reported treatment with opioid analgesics a month before pregnancy or during the three months after conception. In the comparison group of 6,701 women, the rate of opioid treatment was 2.0 percent.

“Opioids and their receptors act as growth regulators during embryologic development, which may explain our findings,” said Cheryl S. Broussard, the paper’s lead author.

Study Undercuts View of College as a Place of Same-Sex Experimentation

Posted: 17 Mar 2011 08:30 PM PDT

The popular stereotype of college campuses as a hive of same-sex experimentation for young women may be all wrong.

To the surprise of many researchers and sex experts, the National Survey on Family Growth found that women with bachelor’s degrees were actually less likely to have had a same-sex experience than those who did not finish high school.

“It’s definitely a ‘huh’ situation, because it goes counter to popular perceptions,” said Kaaren Williamsen, director of Carleton College’s gender and sexuality center.

For years, sex researchers, campus women’s centers and the media have viewed college as a place where young women explore their sexuality, test boundaries, and, often, have their first — in some cases, only — lesbian relationship.

That phenomenon gave rise to the term LUG (lesbian until graduation). In 2003, a New York magazine article, “Bi for Now,” suggested that women’s involvement in their college’s gay scene exposed them to a different culture, like junior year abroad in Gay World.

But according to the new study, conducted by the Centers for Disease Control and Prevention, based on 13,500 responses, almost 10 percent of women ages 22 to 44 with a bachelor’s degree said they had had a same-sex experience, compared with 15 percent of those with no high school diploma. Women with a high school diploma or some college, but no degree, fell in between.

Six percent of college-educated women reported oral sex with a same-sex partner, compared with 13 percent who did not complete high school.

Anjani Chandra was the lead author of the report, based on data from 2006 through 2008.

Although 13 percent of women over all reported same-sex sexual behavior only one percent identified themselves as gay, and another 4 percent as bisexual. To get accurate answers to intimate questions, the researchers asked those surveyed to enter their responses directly into a computer.

“It’s like a Rubik’s cube of sexuality, where you turn it a different way, and the factors don’t fit together,” said Rea Carey, executive director of the National Gay and Lesbian Task Force. “It may be that the commonly held wisdom was wrong, that people just liked to imagine women in college having sex together, or it may be that society has changed, and as more people come out publicly, in politics or on television, we are getting a clearer view of the breadth of sexuality.”

The findings are especially striking — and puzzling — since the previous round of the survey, in 2002, found no pattern of educational differences in women’s sexual behavior. Most of the change came from higher levels of same-sex behavior reported by the women without diplomas.

“I always thought the LUG phenomenon was overblown, in the context of it being erotically titillating for young men,” said Barbara Risman, an officer of the Council on Contemporary Families and a University of Illinois at Chicago sociology professor. She added that the new findings may reflect class dynamics, with high school dropouts living in surroundings with few desirable and available male partners.

Amber Hollibaugh, interim executive director of Queers for Economic Justice, a New York-based advocacy group, said the results of the federal survey underscored how poor, minority and working-class lesbians had been overshadowed by the mainstream cultural image of lesbians as white professionals.

“Working with a gay-rights group is now something you’d put on your résumé,” said Ms. Hollibaugh, who did not attend college. “Lesbians who aren’t college-educated professionals are pretty much invisible.”

Dan Savage, a gay sex columnist in Seattle, said the LUG phenomenon may be overrepresented in the national imagination because so many students sought attention for their sexual exploration: “A lot of them are out to prove something and want their effort to smash the patriarchy to be very visible,” he said.

Lisa Diamond, a professor of psychology and gender studies at the University of Utah, said that with gay relationships so much more common throughout society, college campuses may have lost their status as the “privileged site” for women’s exposure to different kinds of sexuality. “Maybe our stereotypes are just behind the times,” Ms. Diamond said, adding that while lesbian and gay couples raising children were still assumed to be sophisticated white professionals, as in the movie, “The Kids Are All Right,” the latest parenting data showed that “holy-moly, it’s less likely to be upper-middle-class same-sex couples than ethnic minorities and working-class couples.”

Most headlines about the report, released earlier this month, focused on a finding that young people were waiting longer to have sex. Almost 29 percent of the females and 27 percent of the males, age 15 to 24, had had no sexual contact, an increase from 22 percent for both sexes in the 2002 survey.

The gender gap on homosexuality remains substantial: Twice as many women as men reported same-sex behavior. Three percent of the women — and 5 percent of the least-educated women — said they were attracted equally to men and women, compared with one percent of the men.

“A lot of data shows that women’s sexuality is more hetero-flexible, more influenced by what they see around them,” Professor Diamond said.

In the past, she said, a women with a single homosexual relationship would have been labeled gay, and urged to accept that identity. But now there is a growing sense that a lesbian relationship need not define a woman.

“It’s becoming more acceptable, at least in some parts of society, to see your gender identity as fluid,” said Joan Westreich, a Manhattan therapist. “I see women whose first loves were women, who then meet and fall in love with a guy, and for whom it seems to be relatively conflict-free.”

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