Category Archives: Affordable Care Act
HealthCare.gov: After Fixes, More Enroll in First Two Days of December than Did in All of October
The five weeks spent working on many of the problems of the HealthCare.gov website seem to have been time well spent, with more people signing up for the new health insurance in the first two days of December than were able to enroll in all of October. About 29,000 signed up for the insurance, made possible by the Affordable Care Act, on Sunday and Monday; only about 27,000 people signed up in October when the site first went live. While the final numbers have not been released, about 100,000 are estimated to have signed up via the site in November. The website is used in 36 states, with fourteen states and Washington, D.C. running their own sites. Read more on the Affordable Care Act.
Boston Adds Rentable Bicycle Helmets to Bikeshare System
Boston is working to improve the safety of people who use Hubway, the city’s popular bikeshare system, by installing the first vending machine for renting bicycle helmets. The HelmetHub street kiosk will be located at the Boylston Street and Massachusetts Avenue Hubway Station. Riders will be able to rent a helmet for 24 hours for $2, or purchase one to keep for $20; they will be sanitized and inspected after each use. The city intends for this test kiosk to be the first of many throughout Boston. Read more on safety.
Study: Social Ties, More than Biology, Responsible for Changes in Teen Sleep Times
Social ties—especially with parents and friends—may be more responsible than biology for whether a teenager gets enough sleep. While past studies have linked biological development factors to why children tend to sleep less as they age into teenagers, a new study in the Journal of Health and Social Behavior ties the trend more closely to the quality of the teen’s social ties. In an analysis of data on almost 1,000 kids ages 12 to 15—during with the average sleep time drops from 9 hours per school night to 8 hours—researchers concluded that teens who felt that they were a part of school, who were close to their friends and especially who had parents who were active in their life were more likely to get more sleep. "Research shows that parents who keep tabs on their kids are less likely to see them get into trouble or use drugs and alcohol," said David Maume, a sociology professor at the University of Cincinnati. "My findings suggest a similar dynamic with sleep. Parents who monitor their children's behavior are more likely to have kids that get adequate rest. Given that children generally get less sleep as they become teenagers, parents should be ever more vigilant at this stage.” Read more on pediatrics.
Several weeks ago, the Harvard School of Public Health celebrated its Centennial with fanfare, fundraising and a panel discussion featuring world health leaders who are graduates of the school. Following the centennial, NewPublicHealth spoke with the School’s Dean, Julio Frenk, MD, MPH, PHD, who has a joint appointment at the Harvard Kennedy School of Government. He is also a former health minister of Mexico and a former senior fellow in the global health program of the Bill and Melinda Gates Foundation.
NewPublicHealth: What do you think have been the key changes in public health efforts since the Harvard School of Public Health was founded 100 years ago?
Julio Frenk: The 100 years that have passed since the School of Public Health was founded are not just any 100 years—they’re the 100 years with the most intense transformations in health in human history. We have seen a more than doubling of life expectancy since the school was founded. Around 1900, the global average for life expectancy was 30 years. At the end of the century, the global average was about 65 years. It more than doubled in the 20th century, and that increase has continued with some setbacks, most notably the AIDS epidemic in Saharan Africa. And we have had a qualitative shift not just in the level of mortality, but in the causes of death. So we went from a preponderance of acute infections to now a predominance of mostly chronic non-communicable diseases, and that’s an incredible transition.
A critical change is that the experience of illness became very different starting from the beginning of the 20th century. Before then, illness was mostly a succession of acute episodes, from which one either recovered or died. If you recovered, you went on to get your next acute illness. Now, illness is more a condition of living. People live with cancer. People live with AIDS. So that’s a big transformation of the patterns of health, disease and death.
Another big change is the emergence of complex health systems, and that’s—again—a process that started at the beginning of the 20th century. Before the 20th century, the social function of the sick was mostly trusted to undifferentiated institutions, such as the family or religious institutions, and it’s not until the 20th century when you see this incredible explosion of specialized institutions and specialized human resources, doctors, nurses and other health professionals. In the 20th century, healthcare is 10 percent of the global economy and employs millions of people, including eight million doctors. These are all profound transformations.
NPH: How has the training of students of public health changed in the last 100 years?
Frenk: There has been profound change. What happened at the beginning of the 20th century was the emergence of public health as a field of action. The practices of engineering emerged in Europe, especially with the rapid urbanization there starting around the 17th century, but then greatly expanded in the 18th century. Engineering allowed for access to clean water and taking care of waste, which resulted in some diseases coming under control. In the 19th century the discovery of microbiology gave rise to the abolishment of the germs as causes of illness. That is the junction that gives birth to public health, along with the idea of social policy, of social activism that actually changed social conditions. It’s in that mix that public health gets shaped.
Study: Gay, Bisexual Men Who Know Their HIV Status Less Likely to Engage in Risky Sex
Gay and bisexual men who know their HIV status are far less likely to engage in unprotected sex, which in lessens the sexual risk both for them and for their partner, according to the U.S. Centers for Disease Control and Prevention's (CDC) latest Morbidity and Mortality Weekly Report. An analysis of HIV-positive men who have sex with men (MSM) in 20 U.S. cities found that about 33 percent of those who did not know their status engaged in unprotected sex with a partner, and also did not know the status of the partner; men who knew their status were 60 percent less likely to do so, for an overall rate of 13 percent. MSM account for about two-thirds of new HIV infections and about half of the 1.1 million people in the United States with HIV. "While we remain concerned about potentially increasing levels of sexual risk, it is encouraging to see that risk is substantially lower in those who know they have HIV," said CDC Director Tom Frieden, MD, MPH. "HIV testing remains one of our most powerful tools to reverse the epidemic. Everyone should know their HIV status." Read more on HIV/AIDS.
Improved HealthCare.gov Faces Next Challenges
HealthCare.gov, the online portal for the Affordable Care Act, faces another test starting today as the Obama administration announced it met a weekend deadline to make the site easier to use and more accessible for most users. The original launch of the site was met with must frustration across the county as many people were unable to navigate the site properly or even to log in. The administration now expects a rush of people--both a backlog and people who have yet to try the site--to enroll by the December 23 deadline for coverage that would begin January 1. Multiple organizations, including Enroll America and AIDS Alabama, have announced plans to help people enroll. Jeffrey Zients, an administration advisor, warned that the post-Thanksgiving wave of enrollment could still overwhelm the servers at times. Read more on the Affordable Care Act.
Study: Energy Drinks Can Increase Strain on Heart
People who consume energy drinks can experience rapid heart contractions and increased strain on the heart up to an hour later, according to new research to be presented today at the annual meeting of the Radiological Society of North America, in Chicago. The findings raise concerns over the effects of caffeine and taurine on heart health, especially for people who already suffer from heart disease. Researchers used magnetic resonance imaging to measure the heart function of 18 health people both before and after they consumed an energy drink, finding an average 6 percent increase in the heart contraction rate afterward. "We know there are drugs that can improve the function of the heart, but in the long term they have a detrimental effect on the heart," said Williams, a cardiology professor at Wayne State University School of Medicine, in Detroit. Researchers noted that further study is needed to determine the reason for the apparent link. Read more on heart health.
Implementation of the Affordable Care Act—and keeping future generations of Americans healthy or even healthy enough—will rely on an adequate supply of primary care physicians. That includes family physicians, pediatricians and internists who can help steer patients toward healthier lifestyles and effective treatments for chronic illnesses to help avoid both unnecessary complications and costs. However, the Association of American Medical Colleges predicts a shortfall of about 45,000 primary care doctors in the next decade, according to The Wall Street Journal. Many medical students have traditionally avoided primary care training in favor of specializing in fields such as dermatology and radiology because the pay is generally far higher. That matters especially these days, when many medical students leave school owing more than $150,000 for their training.
According to the article, in an effort to increase the number of doctors specializing in primary care, a number of medical schools have strengthened their primary care programs and at least 17 new medical schools have opened since 2005—some that have only primary care training programs. And some of the schools have been able to recruit effectively by building loan repayment programs into the program, especially if students commit to practicing in underserved areas following their training.
Colleen Christmas, director of the internal residency program at Johns Hopkins Bayview Medical Center, who is interviewed in the article, points out that a strategy of increasing the number of primary care doctors makes economic as well as population health sense. According to Christmas, a recent study by Johns Hopkins researchers showed that with each 1 percent increase in the proportion of primary-care physicians, an average city will have 503 fewer hospital admissions, almost 3,000 fewer emergency-room visits and 512 fewer surgeries annually.
Read the full story in The Wall Street Journal.
>>Bonus Link: Four months after Surgeon General Regina Benjamin left her post to return to academia and a medical practice, the White House has nominated Vivek Hallegere Murthy, co-founder and president of Doctors for America and a Boston-area physician, to take up that post.
White House Announces Modification to Affordable Care Act Aimed at Letting Many Keep their Current Health Insurance Coverage
The White House announced on Thursday that health insurance companies will now be permitted to renew many previously cancelled health insurance plans for the upcoming coverage year. The plans had been cancelled by insurers in the last few weeks because they did not include a menu of preventive services—for example, some immunizations provided without a patient co-pay—that are required under the Affordable Care Act (ACA) for health plans that cover people in the United States beginning January 1, 2014. Insurers are allowed, but not required, to reinstate the cancelled plans and will not have to include free preventive services in the renewed plans for 2014.
The roll out of health insurance under the ACA has seen numerous glitches, including difficulty even logging into the health insurance marketplace website. On Thursday, Kaiser Health News posted a very informative FAQ aimed at answering some of the many questions consumers and health experts have right now about signing up for health insurance for 2014.
>>Bonus Link: Read about the Affordable Care Act on RWJF.org.
Administration: Half a Million Have Applied for Health Insurance Under Affordable Care Act
Despite problems with the Healthcare.gov online portal, approximately half a million people have applied for health insurance under the Affordable Care Act. Enrollment for all 50 states and the District of Columbia opened on October 1. As many as 7 million uninsured Americans are ultimately expected to receive coverage through the program. However, as soon as the site launched users began to experience error messages and other technological glitches; the administration pointed to the unexpectedly high volume of visitors as the reason for the problems. "The website is unacceptable, and we are improving it, but the product is good and across the country people are getting access to affordable care starting January 1," said an administration spokesperson, according to Reuters. On the other hand, an article in Politico points out that the numbers being reported are only a piece of the puzzle because the number of people who applied does not equate to the number of people who "actually completed the process of choosing and enrolling in a health plan." And, according to Politico, "Extensive 'glitches'...with the online marketplaces known as exchanges have made it impossible for most people to get all the way through the signup process, even after filling out the initial online application."Read more on the Affordable Care Act.
Study: Friendships Formed on Social Networking Sites Can Help Smokers Quit
The strong supportive bonds formed on social networking sites can help people in their efforts to quit smoking, according to a new study in the Journal of Communication. "I found that people who join health-based social networking sites are able to quit smoking and abstain for longer periods of time because of the sense of community they build with other members," said study author Joe Phua, an assistant professor in the department of advertising and public relations at the University of Georgia's Grady College of Journalism and Mass Communication. Researchers surveyed 252 members of six health-centric websites, finding that the friendships formed online “seemed to boost users' sense of empowerment with respect to their ability to stop smoking for good,” according to HealthDay. Phua said the online support sites are effective because they are cheap and easy to access, while also providing a connection to “a larger and credible community” of people working to quit tobacco. Read more on tobacco.
Study: Spankings Tied to More Behavior Problems in Elementary School
Spankings of five-year-old children are tied to increased behavior problems in elementary school, according to a new study in the journal Pediatrics. Led by Michael MacKenzie, from Columbia University in New York, the researchers analyzed long-term data on approximately 1,900 children, finding that spankings by moms at least twice a week were tied to a two-point increase on a 70-point scale of problem behavior. They also found that regular spankings by fathers were tied to lower scores on vocabulary tests. Elizabeth Gershoff of the University of Texas at Austin, who was not a part of the study, said that while the findings are difficult to interpret, "There's just no evidence that spanking is good for kids. Spanking models aggression as a way of solving problems, that you can hit people and get what you want,” she said. “When (children) want another kid's toy, the parents haven't taught them how to use their words or how to negotiate." Read more on violence.
The shutdown is just one of two government stories making headlines today. The other, of course, is the opening of consumer health insurance marketplaces, also known as exchanges, in every state that will let consumers purchase coverage that takes effect as early as January 1, 2014. (Sign up after December 15, 2013 and coverage could begin after January 1.) The marketplaces are the cornerstones of the Patient Protection and Affordable Care Act (ACA) signed into law three years ago.
The exchanges will not only sell insurance, but also serve as electronic sign-up centers for public health coverage. For example, under the ACA, Medicaid has been expanded to cover many low-income adults; previously in order to qualify for Medicaid, most adults had to have children under 18 years of age as dependents. Information on the exchange websites will let people comparison shop for health insurance by price and other options, as well as find out whether they qualify for subsidies and tax breaks to help cover the cost of the insurance. In a statement released to announce the opening of the marketplaces, the American Public Health Association (APHA) underscored the fact that all Americans using the marketplace will be guaranteed access to health care and a range of preventive services, including cancer screenings; vaccinations; care for managing chronic diseases; and mental health and substance use services.
“This is a defining moment in the transformation of our U.S. health system,” said Georges Benjamin, MD, APHA’s executive director. “Thanks to the Affordable Care Act, Americans will finally have greater access to affordable, quality care and preventive health services. The marketplace gives preventive care to Americans who never had it before, especially the 44,000 who die prematurely every year because they lack health insurance.”
According to the APHA, under marketplace and Medicaid expansion provisions 25 million uninsured Americans will gain health coverage within 10 years and even more will lower their health costs. Other provisions of the ACA include the Prevention and Public Health Fund already in place to improve the health of Americans through proven community-based preventive health services and strengthening of the public health work force and infrastructure.
Experts at the Robert Wood Johnson Foundation have created and compiled resources to help individuals and health experts navigate the exchanges in their states.
>>Bonus Links: Read previous posts about the Affordable Care Act on NewPublicHealth:
- Do You Speak Affordable Care Act? — Sept. 4, 2013
- What’s the Role of Local Health Departments in Implementing the Affordable Care Act? — July 24, 2013
- Health Departments Begin Implementing the Affordable Care Act: NACCHO Annual — July 11, 2013
- How Will the Affordable Care Act Impact Public Health? — Dec. 3, 2012
- RWJF Statement on the Supreme Court's Affordable Care Act Ruling — July 28, 2012
Health Insurance Marketplaces Under the Affordable Care Act Open Today in Every State
Health insurance marketplaces, also known as health insurance exchanges, open today in every state under the Patient Protection and Affordable Care Act, which was signed into law three years ago. Coverage obtained through the exchanges gives purchasers guaranteed access to health care and a range of preventive services, including cancer screenings; vaccinations; care for managing chronic diseases; and mental health and substance use services. “Most importantly…coverage will translate into more opportunities to live longer, healthier and fuller lives,” saidRisa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, which has launched a comprehensive resource site to help individuals, families and small businesses learn about coverage options available to them, and enroll. Read more on the Affordable Care Act.
2010 California Pertussis Outbreak Linked to ‘Personal Belief Exemptions’ to Vaccines
Researchers have linked the 2010 California pertussis—or “whopping cough”—outbreak to parents who refused to have their children vaccinated for other than medical reasons. During the outbreak, 9,120 people became sick and 10 infants died. The study, which was published in the journal Pediatrics, looked at both outbreaks and filed personal belief exemptions, finding that people who lived in areas with high rates of such exemptions were about 2.5 times more likely to live in an area with many cases of pertussis. Approximately 95 percent of a population must be vaccinated in order for it to maintain herd immunity. Read more on vaccines.
Study: Against Medical Advice, 14 Percent of Infants Sleep in the Same Bed as Parents, Caregivers
Despite the associated risks, many infants still sleep in the same bed as parents, other adults and or children, according to a new study in the journal JAMA Pediatrics. The rate has more than doubled since the early 1990s and now stands at about 14 percent. Such sleeping arrangements increase the risk of sudden infant death syndrome (SIDS) or death from other sleep-related causes. Study co-author Marian Willinger, special assistant for SIDS at the U.S. National Institute of Child Health and Human Development, said it is important for doctors to discuss proper sleep-time habits with new parents; the study found that parents who receive advice against sleeping in the same bed as infants are 34 percent less likely to do so. Read more on maternal and infant health.
A recent survey by the American Institute of Certified Public Accountants (AICPA) found that more than half of about 1,000 American adults polled could not correctly define common health insurance financial terms such as premium, deductible or copay. That’s concerning considering that opening day to sign up for health insurance under the Affordable Care Act is October 1. “Half of Americans would fail health insurance 101,” said Ernie Almonte, CPA, chair of the Institute’s National CPA Financial Literacy Commission. “That’s critical insight as consumers prepare to make important decisions with implications for both their physical and fiscal well-being,” says Almonte. “Americans need to take time in the coming weeks to familiarize themselves with key terms and assess their needs so they make the best decisions for their health and financial situations.”
Knowing what the terms mean can help people make informed choices when they sign up for health insurance. For example, a copay is the out of pocket cost to a patient for a health service. Choosing a plan with lower co-pays can help individuals save money, according to the Institute.
The survey found that people with high school diplomas or less education were significantly more likely than those with a college education to be unable to define financial health terms. The survey also found that 41 percent of responders said they were not at all knowledgeable about the Affordable Care Act; just under half of responders said they thought they were somewhat knowledgeable.
The Affordable Care Act (ACA), which kicks into high gear in January, was front and center at the recent annual meeting of the National Association of County and City Health Officials (NACCHO) in Dallas. U.S. Centers for Disease Control and Prevention Director Tom Frieden, MD, MPH, addressed the benefits to population health of many of the new law’s provisions and Kathleen Sebelius, Secretary of the Department of Health and Human Resources, which has overall responsibility for the law, spoke about the ACA via video.
For the most part, the role of local health departments under the ACA is still emerging and will become better known as more provisions are implemented and clarified.
To better understand what we know about that role and what will become better known down the road, NewPublicHealth spoke with Michelle Chuk Zamperetti, MPH, Senior Advisor and Chief of Public Health Infrastructure and Systems for NACCHO.
NewPublicHealth: Are there specific provisions under the ACA that apply to local health departments?
Michelle Zamperetti: There are no provisions specifically designated for local health departments but there are many provisions that impact local and state health departments. For example, many will be involved in the outreach and enrollment efforts for the new marketplaces and some will be designated as navigators to help people enroll for health insurance coverage in both the state-run marketplaces and the federally funded exchanges. For example, I recently learned that authorities managing a state-based health insurance exchange were not pleased with some of the navigator program applicants, so they reached out to a local public health director and asked that health department to be the navigator program leader in their region. And even in communities where health departments don’t give direct enrollment assistance—such as filling out paperwork online—we are confident that people with established relationships with their health department may use it as an entry point for finding out about health insurance, and health departments will need to know how to help them enter the system.
In addition to the insurance expansion provisions of the law, there are also important provisions to strengthen the coverage provided through insurance, particularly in the area of clinical preventive services. For health departments that provide direct services, there are opportunities to become in-network providers under the ACA.
NPH: Do you think many health departments will work together with non-profit hospitals, which now have a mandate from the Internal Revenue Service (IRS) to provide some form of community benefit in order to maintain their tax-exempt, not-for-profit status under the ACA?