Although it hasn’t been mentioned in the fickle world of political commentary for a while, the federal sequester is still very much in effect, and its impacts are starting to be seen in very real terms across the nation and in Minnesota. Recently, the biggest attention-grabber has been the fact that over 57,000 children nationwide are set to be dropped from Head Start, a program focusing on preschool education and supporting children in low-income and non-English speaking families.
Of that 57,000, between 500 and 600 cuts are expected in Minnesota, along with 120 teacher jobs. Those numbers may not seem hugely significant, but consider why these mostly disadvantaged children are being dropped from a program proven to help them. Because of political posturing and gridlock we are letting marginalized kids fall even deeper through the cracks in education.
These are the things government does. The government is not some faceless taxing machine bent on taking away all of your income. Rather, it is the way by which we collectively fund programs that benefit us all, in a way that, despite occasional red tape, operates much more widely and usually with greater efficiency than most non-profits or churches can hope to work. The estimates for sequestration impact bear that out, with a range of cuts that shows just how many aspects of community life are supported by the government.
For example, even beyond this school-prep program, sequestration will hit Minnesota youngsters hard. It is estimated that over 2300 children in the state may lose access to vaccines this year. Unless you’re Michelle Bachmann or Jenny McCarthy, the need for vaccination should be rather obvious. Yet because Washington is stuck making campaign statements constantly, we may even have to cut back on those. There is some debate on this issue, but the fact that we are even having to consider this shows just how ridiculously these cuts are being made.
There can be a legitimate case for cutting down on some wasteful spending in government programs, but the way we are going about that is completely backward. Cutting the funding first does not make programs more efficient, it merely causes panic which leads to cutting meaningful aid. Sequestration has taken this even further, coming down hardest with immediate cuts on programs that tend to do the most good for those most in need.
Politics is not a game of ideological statements, it is a real issue of real significance to those who are left behind in our competitive society. Cutting spending may sound good in a news clip, but to those who need that money to educate their children or give them a vaccine, these cuts are proving nothing but disastrous.
We have all heard this conventional wisdom to stay healthy: exercise regularly and make sure to eat your fruits and vegetables.
Sounds simple enough, right?
All you have to do is take a look at American obesity trends, and it becomes pretty clear that staying healthy is not as easy as this advice makes it out to be.
Weight is complicated. It is multi-factored, with influences coming from an individual’s environment, genetics, and lifestyle.
In the past 30 years, obesity rates have doubled for children ages 6 to 11, and have more than tripled for adolescents 12 to 19.
There is hope however, as these trends are beginning to shift. A recent Center for Disease Control (CDC) report publishing results from 2008-2011 indicates that childhood obesity rates for low-income preschoolers decreased in 18 states.
In Minnesota, the obesity rates for this same sample population went from 13.4% in 2008 to 12.6% in 2011.
This is good news, because a focus on children is essential in combating the nation-wide obesity problem. Currently, 31.6% of American youth are overweight or obese. And obese children are significantly more likely to become obese adults. 80% of obese boys and 92% of obese girls between the ages of 16 and 17 will become obese adults.
Obesity's affects are widespread. This Washington Post diagram illustrates how obesity has the potential to adversely affect everything from a child’s brain to his/her heart. Not to mention that some reports indicate that obesity results in a ten-fold increase in a child’s likelihood of having type 2 diabetes.
While Minnesota fares better than the rest of the nation, with 23.1% of youth as overweight or obese, we have to continue to strive to be better. As we move forward, we need to focus on effective education and fostering a positive environment around food and exercise.
There are few industries as fully driven by myths and misinformation as diet and exercise. You need only turn on the TV, do a simple Google search, or step inside a diet and supplement store to find yourself overwhelmed by an abundance of contradictory information. A New England Journal of Medicine article published this year explains 7 commonly held beliefs about diet and exercise to be myths.
And this confusion trickles down to youth. If parents, schoolteachers, and our community as a whole fail to have a holistic understanding of health, it is unlikely that children will either.
We need to have a general shift in how our society views and addresses weight. Overweight individuals are often stigmatized and blamed for their weight. This stigmatization actually threatens health and is counter productive to obesity prevention efforts. Individuals respond much better to positive motivation and reinforcement than they do to shaming or stigma. This is especially important when it comes to youth, who already tend to face problems with self-esteem and body image. By emphasizing the benefits of healthy living, instead of the side-effects of an unhealthy lifestyle, we as a society can create a positive environment around food and exercise that reinforces itself.
There is no one size fits all approach when it comes to creating a healthy society. Obesity is complex, and necesitates a wide range of efforts to address the many different components. However, what all of these efforts should have in common is an emphasis on accurate information and a positive outlook.
You probably know someone who has diabetes, or perhaps you have it yourself. Managing one’s diet is critically important to controlling diabetes and many other health conditions. Now imagine having no choice over what’s served for your breakfast, lunch, and dinner—for months or years on end. That’s the reality that thousands of Minnesotans experiencing homelessness face every day.
When you’re homeless meals often come from shelters or drop-in centers, which offer little choice. The food is often provided by volunteers, who often have to choose inexpensive menus to affordably feed the crowd. Whole grains and fresh produce are often limited. Desserts and inexpensive junk food are often plentiful. For those with dietary restrictions, whether due to diabetes, allergies, or religious practice, accommodations are limited. If you don’t eat what’s served, you may not eat at all.
The way to control what you eat, of course, is to do your own grocery shopping. Some people experiencing homelessness may visit food shelves, receive SNAP, or buy some groceries on their own. The problem is food storage and preparation, which limits what groceries are actually feasible for someone to use. If you’re staying in a shelter, few offer any kitchen access to their clients. There might be a microwave available if you’re lucky. Those staying in their car or outside might be able to do some outdoor cooking but obviously have no refrigerator. For people who move frequently, porting around 20 pounds of food from a monthly food-shelf visit is inconvenient at best.
We know that people experiencing homelessness often have health problems, either as a cause or result of their homelessness. Last year 51 percent of homeless adults in Minnesota reported a chronic physical health condition. An unhealthy diet only worsens the other stressors of homelessness. The worse these conditions get, the more they cost us all. People lose their ability to work at a self-supporting level, because their bodies limit the employment they can handle. Increasing medical costs come at a public expense, since most people experiencing homelessness have public health insurance or none at all.
A tempting response is to improve access to healthy food for those experiencing homelessness. I’m sure someone somewhere out there is working on a farm-to-shelter campaign. I myself worked with homeless-shelter volunteers to improve the nutritional quality of their meals, and with the shelter residents to improve their knowledge about healthy eating. That’s all well and good, but it shouldn’t be necessary.
The better solution is to end homelessness. If people weren’t spending years in homeless shelters, we wouldn’t have to worry so much about the effects of shelter food. If people had homes of their own with kitchens of their own, our campaigns to improve food access and health education would be more effective. If we needed yet another reason to end homelessness, this is it.
2 Comments ->
“If our financial industry regarded security the way the health-care sector does, I would stuff my cash in a mattress under my bed,” says Avi Rubin, a computer scientist and technical director of the Information Security Institute at Johns Hopkins University.
Two major dangers accompany the lack of security in the health care sector.
The first presents a low probability, but high-risk impact: hacking.
The Department of Homeland Security’s alert reports that researchers Billy Rios and Terry McCorkle discovered products from over 40 different vendors with serious hard-coded password vulnerability. Rios explains that an “unauthorized and non-technical person can get into a medical device and reprogram the device to do whatever they want,” and “you’d never be able to detect it.” Researchers have also discovered means to hack inuslin pumps to inject a lethal overdose and remotely induce heart attacks from a pacemakers.
The second danger, computer viruses, have already infected hundreds of systems. The same malware that affects our home computers can breach systems controlling hospital laboratory equipment. This slows down the system and prevents devices from functioning properly.
While the Federal warnings are recent, the threats are not new, and have gone unaddressed for years. The question then is why?
First, most health care devices are closed and proprietary. This is problematic because it prevents outside researchers from fully discovering potential device flaws. The responsibility then lies fully on the device manufacturers, who may not have enough at stake to invest thoroughly in the daunting task of foreseeing and addressing potential national security threats.
Second, misinformation between the FDA and hospitals is prevalent. Many manufacturers have indicated to hospitals that the FDA disallows updates to approved systems. However, the FDA actually encourages updates as well as virus protection. Therefore, many systems have remained unnecessarily vulnerable.
Third, health care as a whole lacks the same security environment found in other industries. It tends to prioritize efficiency and progress before proper cyber security measures. Manufacturers flood the market with new devices before thorough testing and hospitals implement electronic records before ensuring a secure connection. In addition, hospitals tend to avoid reporting security problems so as to avoid liability, creating a lack of data to confront the problem at hand.
The FDA issued draft guidance recommending changes that device manufacturers and hospitals ought to take. This guidance will aid FDA staff upon reviewing products. The general attitude around cyber security is beginning to change for the better.
While the security culture adapts in the health care field the real question remains for the rest of us: what is the risk?
In regards to hacking, the risk is currently small. University of Minnesota Professor Heimdahl explains, “you have to ask yourself, ‘what’s the motivation to hack into a medical device?’ If you want to hurt someone there are far easier ways to do it.” However, he warns that even if the current threat is small, “it might be something in the future that could be a real serious problem.” If hacking capabilities can expand to affect large numbers at a time, then an attack becomes significantly more likely.
Viruses have already infected hundreds of hospital security system, but there are so far no reports of direct harm to patients. If manufacturers increase anti-virus and updating capabilities for devices and resolve previous misunderstanding between hospitals and the FDA, the future threat can be minimized significantly.
We are lucky that researchers discovered vulnerabilities before the problem became widespread. It is important to keep in mind that while new technology certainly has improved care significantly, there is risk to the equation as well. While we continue to progress, we cannot afford to dismiss security vulnerabilities, and must remain proactive in foreseeing potential problems.
Despite congressional conservatives' efforts, starting January, the Affordable Care Act, otherwise dubbed “Obamacare,” will start implementation at nearly full strength. That means many people without some kind of insurance coverage already, or those looking to change coverage, will need to enroll starting October first of this year.
Of course, that will only happen if people know about the enrollment period, and the individual mandate that is part of the Act. That responsibility has fallen largely to the state level, to mixed results. Here in Minnesota, information has generally gotten out fairly well, thanks to existing programs like MNCare and groups like TakeAction providing good lists of resources for information. However, there are still projected to be 210,000 people in Minnesota alone who will remain uninsured, with over 130,000 of those people not exempted from the mandate.
In states where implementation is not quite as smooth, like Missouri, that number will undoubtedly be higher. By blocking access to information, some states are creating a self-fulfilling prophecy of doom that, while entirely on the state, will be used as proof that Obamacare is some kind of abject failure. Because of petty politics, millions across the country may be left without health insurance, simply because no one was able or bothered to tell them about the new possibilities.
This is a serious problem. As the New York Times explains, the success of an Act like this one is dependent on as much participation as possible. The more people in a shared market like insurance, the less money each individual has to invest in order to garner enough to cover everyone. This is especially true for young people, who are cheaper to cover and drive down average costs. This fact also makes them a prime target for conservative fear-mongering, as their trepidation could seriously damage the effectiveness of reform.
As with most public policy, the effectiveness of health care reform is ultimately dependent on those who put it into practice. Now, the ACA is not so much “Obamacare” as simply “Healthcare,” and we should be doing all we can to make sure that everyone has access to it, regardless of who created the policy.
Change yields confusion, especially when it comes to health care reform. 42% of Americans are unaware that the Affordable Care Act is still in effect, according to the April Kaiser Health Tracking Poll. The confusion does not end there though; about half of Americans report concern over inadequate information pertaining to how the ACA will affect their families.
Many changes are coming by way of health care reform, and when compounded with the politically motivated misinformation circulating across the country, it is hard to know where to begin.
However, for the 14 million currently in the individual health insurance market and the 58 million uninsured, the insurance exchange and related federal tax credit program are perhaps the most important components of the law, and offer a good place to start.
The exchanges have remained highly contentious, with criticism stemming from both the consumer's perspective as well as broader unrest over the potential toll on the Federal deficit.
On the side of the consumer, individuals worry that enrollment will be too complicated and insurance will remain unaffordable.
While enrollment may not be self explanatory, there are several initiatives to streamline the process. Minnesota was one of 17 states that declared a state-based exchange. Minnesota is a unique place when it comes to health care, so it is very good that MNsure will be Minnesota-specific and provide a personalized approach.
In addition, navigators and in-person assisters have been trained to aid those in need of extra enrollment help. The Federal government allocated $54 million nationwide in grants to assist in these programs, and Minnesota set aside an extra $4 million to ensure that they will be effective.
In response to uninsured individuals’ concerns over cost, there is government assistance. Tax credits will be available for individuals with incomes between 100% and 400% of the Federal Poverty Level (FPL) without affordable employer-sponsored insurance (premiums must exceed 9.5% of income to qualify for tax credits); assets will play no part in determining eligibility. As of this year, the FPL is $11,490 for an individual and $23,550 for a family of four.
Tax credits will work on a sliding scale as a percentage of income. While individuals can opt for different levels of coverage, premiums will typically range from 2% to 9.5% of income. Information about specific health plan premiums will not be available until MNsure opens on October 1st, but estimates are currently available through the MNsure calculator.
The Federal government will offer two different types of tax credits beginning in 2014: refundable and advanceable. Individuals with refundable tax credits will be reimbursed upon filing their annual tax return. Those at or below 250% of the FPL qualify for advanceable tax credits, where the government will pay the amount directly to the insurer in order to minimize out of pocket expenses for the individual.
Lastly, there is the question of the deficit. Tax credits make insurance more affordable for the consumer, but do not reduce the total cost. Subsidizing health insurance for millions of Americans is far from cheap, with the Congressional Budget Office (CBO) predicting that “exchange subsidies and related spending” will cost the government $1.075 trillion over the ten year period of 2014 to 2023.
As always though, context is important. The ACA is about more than just expanding insurance coverage. In fact, the ACA contains numerous cost-saving provisions and revenue generating initiatives that the same CBO report predicts “will reduce deficits over the next 10 years and in the subsequent decade”.
And for those who think that we would be better off just repealing the ACA altogether, the CBO estimates that a repeal would actually cost the nation $109 billion more over the 2013-2022 period than following through on implementation would.
All in all, the new insurance exchanges and federal tax credit initiatives are certainly not perfect, but they will still go a long way in improving care, increasing coverage, and minimizing insurance costs for millions.
By 2014, “all Americans will have access to affordable health insurance options,” according to the U.S. Department of Health and Human Services website’s timetable for the Affordable Care Act (ACA).
Universal affordable coverage by 2014 sounds pretty nice, right? Unfortunately it is not quite an accurate portrayal of what is to come.
21 states opposed Medicaid expansion, while 6 are still deliberating. According to the Kaiser Family Foundation, almost two-thirds of those originally expected to gain Medicaid coverage reside in one of these 27 states, with half of those come from just three: Texas, Florida and Georgia. Millions of individuals depended on Medicaid expansion and will consequently remain uninsured. While some will still be able to utilize tax credits, those at or below the poverty line will have little to no access to affordable care.
Fortunately, Minnesotans won't be stuck in this situation because the state was one of the 23 that decided to expand Medicaid coverage. Enrollment is projected to increase by 193,000, or 27.7% by 2022.
Lack of Medicaid expansion is not the only reason for why individuals may still remain uninsured following the ACA implementation, however. The Health & Human Services Guidance on Hardship Exemption Criteria and Special Enrollment Periods outlines 11 circumstances, ranging from homelessness to bankruptcy, where individuals will be exempt from the individual mandate.
While these individuals will not face penalties due to lack of access, the document ultimately recognizes that there are a number of circumstances under which access to affordable health care will still not be feasible.
All in all, the Congressional Budget Office estimates that there will still be about 31 million nonelderly Americans uninsured in 2023. In comparison to the 58 million (over 18% of the population) currently uninsured, that is still a substantial improvement, but it is certainly far from universal coverage.
Minnesota is currently faring far better than the general American population though. Currently about 9.1% of Minnesotans are uninsured, which is nearly 500,000 individuals. The combination of increased Medicaid coverage, implementation of the online insurance marketplace MNsure, and the offering of a basic health program to cover those that do not quite qualify for medicaid, but are unable to afford private insurance, will certainly dramatically reduce the number of individuals uninsured in Minnesota.
However, locally and nationally we are still far from reaching the goal of affordable health care for all.
So, what does this mean for the ACA?
These numbers ultimately demonstrate that we are just at the beginning of health care reform. Yes, the ACA is a step in the right direction, and it will help improve the lives of millions. However, the battle for effective, affordable, and universal health care does not end with the ACA. With health care spending accounting for nearly 18% of GDP, the nation’s poor health ratings in comparison to our peers, and the 31 million who will still lack coverage even after a decade of ACA implementation, we have a long way to go. In short, health care reform is an incremental process, and we cannot afford to grow complacent.
Vaccinations have been discussed quite a lot in the last few years and the recent ascent of Jenny McCarthy, famous for her anti-vaccine views, has sparked quite a lot of criticism from public health officials who fear elevating her will lend credibility to her claims.
At the same time, according to the Star Tribune, the Minnesota Department of Health (MDH) has released new rules requiring additional vaccinations for children which would bring Minnesota in-line with recommendations from the Center for Disease Control (CDC). At a hearing regarding the new rules, members of the anti-vaccination movement testified regarding concerns about vaccine safety.
Concerned we should be, paralyzed we should not. Every medical procedure has some risks associated with it, but that does not stop many people from getting MRIs or X-rays. Individuals should consult their doctors and make the decision that is right for them, but from a policy perspective the issue is black-and-white.
A report from the Institute of Medicine that reviewed over a 1,000 research articles regarding risks associated with vaccines and concluded, “Vaccines offer the promise of protection against a variety of infectious diseases. Despite much media attention and strong opinions from many quarters, vaccines remain one of the greatest tools in the public health arsenal. Certainly, some vaccines result in adverse effects that must be acknowledged. But the latest evidence shows that few adverse effects are caused by the vaccines reviewed in this report.” Ellen Wright Clayton, professor of pediatrics and law at Vanderbilt and one of the authors of the report said, “The findings should be reassuring to parents that few health problems are clearly connected to immunizations, and these effects occur relatively rarely.”
The report and press release contain more details about the specific types of relationships they found, but the lesson for policymakers it is clear that for the population as a whole, vaccinations are good policy. Still not convinced? Just take a look at this table from the National Institute of Allergy and Infectious Disease regarding the impact of vaccines in the United States:
Some people might view this as an issue of individual choice; people can choose for themselves to be vaccinated or not. But from a public health perspective, such a world view can be down-right deadly.
When people choose not to vaccinate themselves, they can become carriers for diseases like whooping cough. This reduction in herd immunity puts some of the most vulnerable members of our society at risk. Particularly infants who are too young to be vaccinated and rely on those around them forming a protective shield of immunity to keep them healthy. I wrote a blog last year that discussed the outbreak of whooping cough in Minnesota that was caused, in part, due to a lack of vaccination.
While anti-vaccine advocates have powerful emotional appeals, the public health community has, what we call in the biz, science. Policymakers would do well to keep in mind the big picture regarding the population health benefits of vaccinations.
3 Comments ->
Most of us wouldn’t be surprised to hear that our community can influence our health. More surprising might be that differences in life expectancy can be distilled down to neighborhood level. Take a look at this new Minneapolis-St. Paul map from the Robert Wood Johnson Foundation:
The findings are striking: life expectancy may vary by thirteen years in neighborhoods just three miles apart. From the looks of it, the neighborhoods with the highest life expectancies are also those known to have higher home values and higher resident incomes.
This brings us to the classic “causation versus correlation” debate. We know that your address often determines how easy it is to access the amenities that keep us healthy: doctors’ offices, grocery stores, farmers markets, and exercise opportunities, to name a few. You won’t find a Lifetime Fitness or natural foods store in some neighborhoods.
Address is also a proxy for income, and we know that income affects health. Fitness classes, healthy food, and medical care are often expensive. Public safety is also a factor. Violence robs some communities of too many young people; according to recent CDC research, homicide lowers the average life expectancy for African-American males by nearly a year. In addition, people concerned for their safety may be less likely to exercise outside, visit parks, or travel extensively to access things like medical care.
We should also consider whether people moving into low-income neighborhoods are less healthy in the first place. That’s possible, given that people who suffer serious illnesses or disabilities often have lower incomes that may lead them to cheaper neighborhoods. (One study suggests that Americans with disabilities have about 65 percent of the income of those without disabilities.) Of course, the lack of access to healthy amenities once they get there doesn’t help the situation.
None of this is rocket science; we’ve long known that low-income communities suffer worse health. But now we can clearly see that worse health affects not just quality of life, but quantity of life as well.
What seemed like a distant hope back in the 2008 election cycle, is only a few months from becoming a reality for thousands of Minnesotans: near universal health insurance.
It’s not the single-payer system many Minnesota progressives fought so hard to promote, and it makes major free-market concessions. However, the new health insurance exchange (HIX), MNSure, set to begin enrolling Minnesotans in October, marks a major step forward to ensure all people have access to the health treatment they need.
With a few rare exceptions, Minnesota conservatives have tried to block or derail Minnesota’s Affordable Care Act (ACA) implementation. They introduced legislation to kill the ACA in Minnesota, and then refused to attend meetings on the formation of a HIX. Once it was apparent HIX was going forward, they tried to water down its effectiveness.
Now, national conservatives are trying to scare people in early ACA adopter states, like Minnesota, about rate hikes using out of context price comparisons. Minnesota 2020’s Kevin George explains that while in some cases upfront costs might rise, Minnesotan’s long-term out of pocket costs will potentially produce thousands in savings. His piece further highlights that the quality of coverage offered on the exchange is much higher than in currently available barebones plans.
They’re also using the Obama administration’s decision to delay the employer mandate as a reason to also delay the individual mandate. Our Annalise McGrail reality checked the employer mandate delay, and found it would have little impact on uninsured individuals. Although, we still would have liked the administration to stand firm on an equitable application of the policy.
These are just some of the many concerns and questions Minnesotans have about MNSure and the ACA’s overall implementation. That’s why Minnesota 2020 is hosting an online Tuesday Talk discussion tomorrow on our main site. We’re excited to have Phillip Cryan, a member of Minnesota’s health insurance exchange taskforce join us to answer your questions about the HIX and the ACA. Our live discussion with Phillip runs from 8:30-10am. But the forum will be open all day.
Please join us for this informative and energizing conversation.