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What Is The Affordable Care Act? What Is Obamacare?

What Is The Affordable Care Act? What Is Obamacare?

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Main Category: Health Insurance / Medical Insurance
Also Included In: Medicare / Medicaid / SCHIP;Â Â Public Health
Article Date: 29 Jun 2012 - 18:00 PDT

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The Affordable Care Act, also known as the Patient Protection and Affordable Care Act (PPACA), and informally as Obamacare, was signed into law by President Barack Obama on 23rd March, 2010. The aim of the Act is a health care law aimed at improving the health care system of the United States by widening health coverage to more Americans, as well as protecting existing health insurance policy holders.

According to the Obama Administration, those who already have health insurance will benefit from the legislation in various ways. For example, insurance companies will not be able to cancel coverage if people get sick, out-of-pocket costs will be covered for proven preventive and screening services, such as mammograms (breast screening) and colonoscopies. The aim is to diagnose potentially chronic and serious diseases earlier on, when treatments are most effective.

People with jobs but no health insurance, as well as those as those with pre-existing conditions, such as asthma or cancer should find it easier to have reliable health care coverage as a result of the 2010 legislation. According to the US government, in 2014 more Americans will have access to health care coverage.

The Affordable Care Act aims to help small businesses get health insurance for their workers. According to the US government, the Act should "help increase the number of primary care physicians, nurses, physician assistants and other health care professionals."

Below are some highlighted details on the Affordable Care Act:

Young adults can remain on their parents' health plans until they are 26 years old. This will also include young adults who don't live with their parents, are out of school, are not financially dependent on their parents, and are married (however, spouses and offspring will not be covered).
Even if the young adult has gone off a parent-owned plan, they will be able to enroll again.
Parents whose plans were already in place before March 23rd, 2010, can enter their young adult children into their plans if those are not eligible for their own employer-sponsored plan.
Group plans which started before the Affordable Care Act was signed into law do not have to offer health coverage to young adults who qualify for other group coverage.

Employers with fewer than 25 workers may receive help in funding the cost of providing health insurance. Some small businesses are taking advantage of new tax credits which makes the purchasing of health insurance for employees more affordable. Small businesses are eligible if they provide health care for their employees, have no more than 25 full-time workers, and pay an average yearly salary of less than $50,000. Starting in 2014, the tax credit will be 50% for small businesses and 35% for non-profit ones.

Kids with pre-existing conditions may not be denied health coverage by insurance companies. This applies to people up to the age of 19 years and includes any pre-existing health problem, disease or disability that developed before their parents applied for health coverage.
In 2014 this will apply to anybody, regardless of age.
Premiums will not be allowed to be raised for babies or children because of a pre-existing condition or disability.

Adults who have been denied coverage because of an existing precondition and have been uninsured for 6+ months may now get insurance. PCIP (Pre-Existing Condition Insurance Plan) is aimed at adults who could not get coverage because of a pre-existing condition, such as diabetes or cancer. In 2014, access will be available to them.
Individuals in the "doughnut hole" now receive a 50% discount on brand named prescription medications and a 7% discount on generic ones. Those enrolled in the Medicare Part D program often fell into a "coverage gap", commonly referred to as a doughnut hole. As soon as their plan had spent a pre-determined amount of money, further expenses had to be paid for fully out-of-pocket. The new legislation aims to gradually eliminate this problem, so that it no longer exists by the end of this decade.

Medicare patients are now eligible for mammograms, colonoscopies, and some other preventive services

All new health policies must offer screening and preventive services free of charge (mammograms, colonoscopies, etc.)

The following benefits will soon come:

Health insurance policies will be available for all people with pre-existing conditions (companies will not be allowed to refuse them). As from January, 2014, refusing coverage because of a pre-existing condition or disability will not be possible. Companies will not be allowed to raise premiums for those reasons either.
What is a pre-existing condition? This is a health problem, disability or disease that started before the individual applied for health coverage.
As from January 2014, health insurance companies will not be able to raise premiums because of an individual's gender or health status - this applies to individual and small group markets (small businesses that buy health insurance for their employees).

Essential health benefits and coverage will be guaranteed for almost all Americans. As from January, 2014, policies will be required to offer a set of basic benefits which will be available on state-based marketplaces (exchanges). All exchanges will list the health plans on offer, so that people can make comparisons and shop around for the best plans. By 2014, all Medicaid state plans must offer at least:
- Chronic disease management (such as asthma or diabetes)
- Emergency room visits
- Hospitalizations
- Laboratory services
- Maternity and newborn care
- Mental health
- Prescriptions
- Preventive care

The majority of Americans who do not already have health insurance or health coverage will have to make sure they do in 2014. Financial assistance will be available for those who cannot afford it. Individuals who decide not to be covered will have to pay a fee - many call this a form of taxation (in fact, in a Supreme Court ruling yesterday, they allowed the introduction of the word "tax" when referring to this part of the Act). Individuals who pay over 8% of their monthly income to buy health insurance will be exempt.

Dollar limits on the amount of care people are entitled to with insurance companies will eventually be done away with

Exchanges will be created in 2014, state-based marketplaces where Americans without insurance will be able to buy health insurance. The aim is to increase competition between insurers in a state and allow people to compare and shop around for health plans that suit their circumstanc es and pockets.

A larger percentage of American citizens will have access to Medicaid health coverage

Affordable Care Act - What do people think?

Polls vary significantly on what the majority of Americans think - but the trend seems to be that slightly more do not support the law overall, while certain elements within it are very popular. While Republicans and Independents are mainly against the law, the majority of Democrats are in favor.

Many commentators have noticed that although most people are against the new law overall, they are mainly in favor when asked about specific provisions within it.

A Reuters-Ipsos poll carried out on 24th June 2012 showed that:

56% of the US adult population were generally against the law. 44% supported it

75% of Democrats, 14% of Republicans and 27% of Independents support the law overall

82% of Americans agreed that insurance companies should not be allowed to deny coverage for those with pre-existing conditions

61% agreed that young adults should be allowed to remain on the parents' insurance plans up to 26 years of age

72% agreed that companies with over 50 employees should provide their employees with health insurance

61% were against forcing everyone to have health insurance. This part of the law was favored by 41% of Democrats, 27% of Independents, and 19% of Republicans.

There was overall support for the creation of insurance pools so that small companies and uninsured people may have access to insurance exchanges, as well as financial help for families which cannot currently afford health insurance

Is US Healthcare spending good value for money?

Source: The Economist

From 1960 to 2009, US Healthcare spending rose from 5.1% of GDP (Gross Domestic Product) to 17.4%. The figure today is estimated to be even higher. Today, even though the country uses up a significantly higher percentage of its economy on healthcare, the USA has over 50 million people with no health coverage at all, and tens of millions of others with "inadequate coverage" - a situation exclusive to America when compared to other rich nations.

In the United Kingdom, for example, only 8% of GDP is spent on healthcare, and health coverage is offered to all its citizens - the UK has a universal coverage healthcare system. In Japan people live nearly ten years longer, on average, than Americans do, and spend considerably less on healthcare.

The USA has fallen behind other rich nations in life expectancy, infant mortality, teenage pregnancies, and a series of other healthcare statistics.

In 2011 the USA ranked 50th in global life expectancy. Although the country's people are living longer than before, the increase in lifespan in other countries has improved at a much faster rate. (Link to article)

Whatever arguments people of different affiliations use in America regarding its healthcare system, most have to agree that it has become extremely expensive and provides very poor value for money, compared to what other rich nations have managed to achieve.

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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Health Care Reform: Questions and Answers

Health Care Reform: Questions and Answers

Health Care Reform: Questions and Answers

June 29, 2012 -- The Supreme Court's decision on the health care reform law left many people confused about their health insurance and what will happen in the future. Here, WebMD answers some of the most common questions that came in from readers after the ruling.

How does this decision affect those with a preexisting condition?

Starting in 2014, insurers will no longer legally be allowed to deny coverage to anyone because of their medical condition or charge them more for that coverage.

How will it affect people that already have good health insurance and a preexisting condition?

If you already have private insurance or you're enrolled in Medicare or Medicaid, you will not be required to buy new or additional insurance because of the health reform law. Generally, you can stay with your current plan if you're happy with it.

Many people who buy insurance on their own (meaning they don't get it at work) and have a preexisting medical condition, however, have held onto pricey coverage because their health condition prevents them from switching plans. Starting in 2014, these people will have greater freedom to shop for coverage and to determine if another plan better suits their needs, because insurers will no longer be allowed to deny people coverage based on prior medical diagnoses.

How can I afford to buy health insurance if I am currently uninsured?

One of the law's major goals is to make health insurance more affordable.

If you don't get insurance through your job, you will be eligible to buy coverage through state-based insurance marketplaces scheduled to be up and running for open enrollment by fall 2013 for insurance coverage that will start in January 2014. To make insurance affordable for millions of Americans, tax credits will be available for people with incomes that are between 133% and 400% of the poverty level (up to $92,200 annually for a family of four in 2012).

There will also be caps placed on how much people will be required to spend in total out-of-pocket costs, including deductibles, co-pays, and co-insurance. These amounts will also be determined based on a person's income.

"The bottom line is there is help to pay for out-of-pocket costs and help to pay for premiums," says Mila Kofman, JD, a research professor at Georgetown University's Health Policy Institute.

In addition, the law expands the number of people who qualify for Medicaid, the state and federal health insurance program for people with low incomes. That means millions of people who don't qualify for Medicaid today will in 2014. An individual that makes less than $14,856 or a family of four that earns less than $30,657 will be eligible.

I thought the Supreme Court changed something about the Medicaid expansion rules.

It did. The Supreme Court's decision now gives states the freedom to decide for themselves whether they want to expand their Medicaid program. "They don't have to," Kofman says.

People who live in states that choose not to participate may find themselves without insurance coverage in 2014. However, Kofman says, states will likely be under pressure from hospitals and insurance companies that rely on that money to expand their Medicaid programs to include more people.

Music and Your Workout: Playlists, Volume, and More

Music and Your Workout: Playlists, Volume, and More

Music and Your Workout

It's one of the most famous movie moments -- rookie boxer Rocky Balboa charges to the top of the Philadelphia Museum of Art staircase, punching and jabbing to Bill Conti's anthem, "Gonna Fly Now." It's 1976, and the era of portable electronic devices is years away. But what if Rocky had been listening to that song on an MP3 player during his workout? Could he have run up those steps even faster?

Maybe. Music can motivate you to work longer and harder, says David-Lee Priest, PhD, a health psychologist and researcher at London's Brunel University.

But before you reach for your headphones, know this: There's a downside to pumping up the volume.

Slideshow: Natural Ways to Fuel Your Workout

Working Out to Music

Music may boost endurance -- but not of your muscles, of your brain.

"Fast music, especially, provides us more information to process, which may distract someone from the physical sensations of fatigue and block signals to stop exercising," Priest says.

But not all fast songs do that. If the music is too fast, it isn't likely to enhance performance or endurance, says Costas Karageorghis, PhD, deputy head of sports psychology at Brunel University. He has studied the effects of music on exercise for more than 20 years.

"Findings show there is a sweet spot, in terms of tempo, between 120 and 140 beats per minute," Karageorghis tells WebMD. "Beyond that, it doesn't improve enjoyment or any other psychological variable while exercising."Â

That's also true if you're working out at a very intense level, or about 70%-80% of your aerobic capacity, he says. In fact, for most elite athletes, music only has a small effect on performance.

That's because most athletes already have excellent focus when it comes to regulating their movements and reaching a particular goal, Karageorghis says. Music may be too distracting and even hinder performance for some professional athletes, he says.

But for the average person who exercises at a moderate level a few days a week, music can and does enhance working out. Unlike athletes who train for a living, most people actively seek distractions while working out. Listening to music may ease the boredom they associate with exercising, Karageorghis says.

For them, music is like the "cheese sauce on top of the broccoli," Priest agrees. That is, music helps them tolerate exercise, and may motivate them to work out more often.

Choosing Your Exercise Playlist

Sure, you have your personal preferences. But whatever musical style you favor, you might want to check the beats per minute (bpm). You can look for apps that can help you determine the bpm.

Karageorghis suggests choosing songs that mirror your heart rate, depending on the level of exercise.

For instance, he recommends slower songs that have tempos within the 80-90 bpm range, like "Stereo Heart" by Gym Class Heroes or "Twilight" by Cover Drive, when you're warming up or cooling down.

As you pick up the pace to a moderately intense level, Karageorghis says songs within the 120-140 bpm range are ideal -- such as "Starships" by Nicki Minaj (125 bpm), "Domino" by Jessie J (127 bpm), and "Turn Me On," by David Guetta featuring Nicki Minaj (128 bpm). Songs over 140 bpm are unlikely to improve workouts, he says.

Fewer Women in 40s Getting Mammograms

Fewer Women in 40s Getting Mammograms

Fewer Women in 40s Getting Mammograms

June 29, 2012 -- Mammogram rates in the U.S. have declined by nearly 6% among women in their 40s since screening guidelines were revised in 2009, according to a new study.

"This represents a small but significant decrease," say the Mayo Clinic researchers, because the guideline changes were controversial when they were released.

With the revised guidelines, the U.S. Preventive Services Task Force (USPSTF) called for mammograms to begin for women at average risk at age 50 and occur every two years until age 74. This was a change from its 2002 recommendations, which called for women to have mammograms every one to two years starting at age 40.

But the task force health experts concluded the benefits of screening women 40 to 49 did not outweigh its harms. They also believed there was not enough evidence to suggest that mammograms were effective for women 75 and older.

In contrast, the American Cancer Society guidelines call for yearly mammograms for women at average risk starting at age 40 and continuing for as long as a woman is in good health. Unlike the USPSTF, they do not recommend an age cut-off for the screening test.

"The 2009 USPSTF guidelines resulted in significant backlash among patients, physicians, and other organizations, prompting many medical societies to release opposing guidelines," study researcher Nilay Shah, PhD, says in a news release. He is a researcher at the Mayo Clinic Center for the Science of Health Care Delivery in Rochester, Minn.

The new findings were presented this week at the Academy Health Annual Research meeting in Orlando.

Slideshow: Essential Screening Tests Every Woman Needs

Modest Drop in Younger Women

Researchers wanted to find out what impact the new mammogram guidelines -- and the debate over them -- had on the screening rates in younger women.

For this large study, they analyzed health insurance claims data from nearly 8 million women aged 40 to 64 nationwide. They tracked women who had mammograms between January 2006 and December 2010, a time period before and after the screening guidelines were updated.

When researchers compared the mammogram rates before and after the new changes, they found a nearly 6% drop in screenings in women 40 to 49. They estimate this meant that about 54,000 fewer mammograms were done in this age group one year after the guidelines were revised, which they describe as a "modest effect."

"A modest effect is also in line with the public resistance to the guideline change and the subsequent release of numerous conflicting guidelines," the researchers write.

During the same time frame, the changes were shown to have no effect on mammogram rates in women 50 to 64. Researchers suggest this reflects a more subtle change in the screening guidelines, which went from yearly to every two years in this age group, compared to a "more radical change" in younger women.

This study was presented at a medical conference. The findings should be considered preliminary, as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

Aging Eyes Are Seeing Better

Aging Eyes Are Seeing Better

Aging Eyes Are Seeing Better

June 29, 2012 -- There has been a dramatic drop in vision impairment among older Americans over the last generation, new research shows.

The prevalence of self-reported eyesight issues that limit activity declined by well over 50% in just two and a half decades, according to data from two nationally representative surveys.

In 1984, close to 1 in 4 older people reported having problems reading newspaper print because of vision loss, compared to 1 in 10 in 2010.

"This is really excellent news," says researcher Angelo P. Tanna, MD, who is vice chair of the department of ophthalmology at Chicago's Northwestern University Feinberg School of Medicine.

"The prevalence of activity-limiting visual impairment is decreasing and has been decreasing," he tells WebMD.

Better Cataract Surgery

Although the study did not explore the reasons for the reduction, Tanna says advances in cataract surgery, declines in smoking, and better treatments for diabetes have all played major roles.

Ophthalmologist Richard Bensinger, MD, tells WebMD that cataract surgery has become routine and complications are now rare.

Bensinger practices in Seattle and is a spokesman for the American Academy of Ophthalmology.

"A generation ago, people waited until a cataract was so bad that even a bad surgical result was better than the alternative," he says. "These days, most people have surgery at the first sign of visual discomfort."

Just 1 in 5 adults in the U.S. smoke cigarettes today, compared to 1 in 3 in the 1980s.

Smoking is a major risk factor for macular degeneration, which is one of the most common vision diseases in the elderly.

"The prevalence of age-related macular degeneration has gone down, and studies suggest that smoking declines are a big reason for this," Tanna says.

Better Diabetes Control

Diabetes is a leading cause of blindness, and age and obesity are leading risk factors for obesity.

Tanna says even though diabetes rates in the U.S. continue to climb, better therapies are now available to prevent and treat diabetes-related vision issues.

"Diabetes patients are getting better care than they did in the past, and this has led to less vision loss among people with this disease."

It is not clear if advances in screening for age-related vision issues have contributed to their decline.

But Bensinger says regular eye exams are important for everyone as they age, especially people with diabetes and other health conditions that can lead to vision loss.

The study appears in the latest issue of the journal Ophthalmology.

Who Gets Covered Under Health Reform?

Who Gets Covered Under Health Reform?

Who Gets Covered Under Health Reform?

June 29, 2012 -- The Supreme Court decision to uphold key provisions in the Affordable Care Act, or ACA, cleared up one question: Will the law stand (for now)? But for many people, that was about all they found clear.

There's still a lot of confusion about who will be covered, will the goal of insuring the uninsured be met, and what happens if I have preexisting conditions?

The court's decision did put a kink in President Obama's plan to extend health insurance to an estimated 32 million uninsured Americans.

More than half of the people meant to gain coverage under the health reform law were supposed to get free coverage under a major expansion of the Medicaid program.

That means, if you're struggling to make ends meet, you wouldn't pay a dime.

Now there's a hiccup in that plan.

After yesterday's decision, states cannot be forced to participate in the Medicaid expansion. That could leave millions of Americans without the coverage promised under the law.

"You've got a lot of conservative governors saying, 'You can't force us to expand Medicaid this way. We can't afford it,'" says Robert Laszewski, president of Health Policy and Strategy Associates in Alexandria, Va.

"Now the court has said, I think very appropriately and fairly, the feds can't take the original Medicaid funding away if you don't do the expansion," Laszewski says.

In effect, the ruling forces states to "put up or shut up," he tells WebMD.

"You don't want the money? You don't have to have the money. But then you go face your constituents and tell them why you didn't expand Medicaid like the other states," he says.

Who Pays for What?

Here's what the numbers look like. From 2014 to 2016, the federal government pays the entire cost of the Medicaid expansion. After 2016, the portion of the costs paid by the federal government begins to decline. By 2020, states would have to kick in 10%.

Ten percent may not sound like much, but some states are saying it could be financially crippling.

In Georgia, a state that sued to block the ACA, Gov. Nathan Deal says he's weighing his options.

''Even with federal help, the state would have to find another $4.5 billion over the next 10 years to pay for the Medicaid expansion.

In Indiana, Gov. Mitch Daniels said in a statement that the expansion would put 1 in 4 Hoosiers on the Medicaid rolls at a cost to the state of $2 billion over the next 10 years.

"I think states will turn it down," says Marc K. Siegel, MD, an infectious disease expert at New York University's Langone Medical Center in New York City, and also the physician coordinator of Doctor Radio.

"In New York, it's a billion dollars or more to administer the Medicaid expansion. So a key problem here is not in terms of Medicaid, which the feds are picking up the cost of for the most part, but the administration of the additional Medicaid patients," Siegel says.

FDA Approves New Appetite Suppressant Belviq From Arena Pharmaceuticals

FDA Approves New Appetite Suppressant Belviq From Arena Pharmaceuticals

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Main Category: Obesity / Weight Loss / Fitness
Article Date: 29 Jun 2012 - 13:00 PDT

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The weight loss and obesity issue is rapidly over taking tobacco as the number one health concern for the coming decades. According to Centers for Disease Control and Prevention, more than one-third of adults in the United States are classified as obese. With that in mind, the FDA approved a new appetite suppressant called Belviq (lorcaserin hydrochloride) from Arena Pharmaceuticals.

The drug is used for weight management in those who have either high blood pressure, high cholesterol or type 2 diabetes and have a BMI (Body Mass Index) of 27 or greater. A BMI of 27 makes someone overweight, while a BMI of 30 classifies them as obese. It should be used for chronic weight management as an addition to a reduced calorie diet and exercise.

Belviq, which is manufactured by the Swiss based company Arena Pharmaceuticals Gmbh., is a slightly different approach to finding the holy grail of weight management. In an approach somewhat similar to the drug Chantex for quitting smoking, it works by reducing cravings. Belviq activates the serotonin 2C receptor in the brain and should help a person eat less and feel full after eating smaller amounts of food.

Janet Woodcock, M.D., director of the FDA's Center for Drug Evaluation and Research

"Obesity threatens the overall well being of patients and is a major public health concern ... The approval of this drug, used responsibly in combination with a healthy diet and lifestyle, provides a treatment option for Americans who are obese or are overweight and have at least one weight-related comorbid condition."

The safety and effectiveness of Belviq has been evaluated in three randomized trials that took place over 1-2 years and involved some 8,000 overweight and obese patients some of whom were also suffering type 2 diabetes. The patients also engaged in lifestyle changes, including exercise and a reduced calorie diet. When compared with those on a placebo, the average weight loss ranged from 3 to 3.7%.

Those patients not suffering from type 2 diabetes lost at least 5 percent of their body weight, compared with only 23 percent on the placebo. 38 percent of patients with type 2 diabetes and 16 percent treated with placebo also lost at least 5 percent of their body weight. Belviq also seemed to help those with type 2 diabetes, presumably the reduction in cravings, meant less intake of snacks, as favorable changes in glycemic control were seen. The FDA recommended that a labeling be included with the drug to recommend patients not losing weight after 12 weeks to cease taking the drug, because trials suggest that the drug will not be effective for them in obtaining a meaningful weight loss.

Belviq can cause some serious side effects, particularly when taken with other medicines that increase or activate serotonin levels, such as those used to treat depression and migraine. Belviq cannot be used during pregnancy and may also cause memory and attention issues. The drug was previously denied approval in 2010 due to concerns of tumors found in animal tests.

It is known that the number of serotonin 2B receptors may be increased in patients with congestive heart failure, therefore the FDA recommended using it with caution in patients with this condition. The Belviq clinical trials included echocardiography to assess heart valve function in the 8,000 patients and while no serious changes were seen between those on the drug, and those on the placebo, the FDA feels the caution is more than warranted after previous experiences with these kinds of weight loss drugs. Back in 1997, fenfluramine and dexfenfluramine had to be taken off the market with evidence emerging that they caused heart valve damage. At the time, it was thought that the effect was related to activation of the serotonin 2B receptor on heart tissue, but in Belviq used at the approved dose of 10 milligrams twice a day there doesn't appear to be activate the serotonin 2B receptor occurring.

The FDA said it will require the drug's manufacturer to conduct six postmarketing studies, including a long-term cardiovascular assessment, to ensure levels of heart attack and stroke are not increasing in those on the drug. The most common known side effects of Belviq in non-diabetic patients are headache, dizziness, fatigue, nausea, dry mouth, and constipation, and in diabetic patients are low blood sugar (hypoglycemia), headache, back pain, cough, and fatigue.

Written by Rupert Shepherd
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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