The [State] Politics of Health Insurance

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In the rush to repeal the Affordable Care Act, the Trump Administration has been repeating the mantra that the individual insurance marketplaces are “failing.” Like most statements made by politicians these days, the facts seem to be a little different.

Clearly, Iowa is in crisis. With the withdrawal of Aetna from the individual marketplace, there is a real risk they may have no insurers offering individual coverage through the marketplace in 2018.

My suspicion is that Aetna’s withdrawal has more to do with its stock price and financial liabilities after a failed merger attempt than with the ACA itself. Aetna has also stopped writing small group insurance in some states.

However, Pennsylvania has six carriers committed to the marketplace for 2018. The only concern is what the Trump administration might do the mess things up.

Further, another insurer, Centene, has announced that it is expanding individual marketplace coverage into three new states — Kansas, Missouri and Nevada.

So what’s the real story with Iowa? If the fault were with ACA, it would be impacting every state and every carrier, and that’s not the case. What have state officials done to mess things up?

If you know the story, please reply. I’d like to know, both about Iowa and about other states where local officials are whining about Obamacare. Let’s get the full story out into the open.

 

Parenting and Risky Sexual Behavior in Teens

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It may sound obvious, but parents matter. Both parents matter.ben_franklin

However, when it comes to risky sexual behavior in teen daughters, the spotlight is on the father.

A new study from the University of Utah relates the “quality of fathering” with teen behavior.

  • High quality fathering is associated with setting standards for behavior and consistent monitoring of how the teen spends her time and money. It affects with whom the teen associates and reduces the likelihood of risky behavior.
  • Low quality fathering does just the opposite.

The study strongly suggests that having a low quality father out of the home may be better for daughters than keeping the family intact.

The study may in fact underestimate the negative effects of low quality fathering. In some cases, parents or other family members are the source of risky behavior.

According to an The Atlantic article from 2013,

One in three-to-four girls, and one in five-to-seven boys are sexually abused before they turn 18, an overwhelming incidence of which happens within the family. These statistics are well known among industry professionals, who are often quick to add, “and this is a notoriously underreported crime.” (2)

Another review of the research literature suggests a 40% rate of molestation among girls and 30% among boys in the US. (4) In all cases, the figures are subject to some disagreement about definitions.

For those of us who know victims  of family abuse, this incidence is quite plausible. In my own conversations, I’ve been flabbergasted by the people who reveal histories of abuse — people I would never have suspected. It comes out in conversations after a certain level of trust is in place. And it surfaces too many times with too many people.

Ultimately, the statistics we have are unreliable, because too many people won’t talk about this. The statistics are incomplete, as they tend to focus on father-daughter abuse and not on mother-son or sibling relations (or on abuse by authority figures other than priests).

Traditional studies have focused on “broken” families and the importance of having two parents in the home. The truth seems to be a bit more complex. There are many cases in which the “intact” family is broken and dysfunctional, and breakup represents improvement.


Sources:

  1. Danielle J. DelPriore, Gabriel L. Schlomer, Bruce J. Ellis. Impact of Fathers on Parental Monitoring of Daughters and Their Affiliation With Sexually Promiscuous Peers: A Genetically and Environmentally Controlled Sibling Study. Developmental Psychology, 2017; DOI: 10.1037/dev0000327
  2. Mia Fontaine, “America Has an Incest Problem,” The Atlantic, 24 January 2013. https://www.theatlantic.com/national/archive/2013/01/america-has-an-incest-problem/272459/
  3. Margaret Ballantine and Lynne Soine, “Sibling Sexual Abuse — Uncovering the Secret,” Social Work Today Vol. 12 No. 6 P. 18. http://www.socialworktoday.com/archive/111312p18.shtml
  4. Rational Skepticism.org. “Just how common is incest?” 11 July 2010. http://www.rationalskepticism.org/social-sciences/just-how-common-is-incest-t9841.html

Impact of Weight on Friendships Between Children

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In a previous post, we discussed the link between being overweight as a child and being bullied. A new Dutch study adds to this, by documenting how excess weight affects friendships between children.

Overweight children face a form of social isolation.

  • Overweight children tend to think they have friends, when those people may not like them.
  • Overweight children tend to be excluded from friendships more often than are children of normal weight.
  • Overweight children see themselves as having more enemies than do children of normal weight.

The previous research suggested that these emotional effects may linger into  high school and young adulthood and be linked to depression and to self-harmful behaviors such as alcohol and drug abuse.

The growing literature on weight and the interactions between children strongly suggests the need to channel children at an early age into some form of physical activity, preferably team-based. If over-weight and isolation are harmful, team sports led by an appropriately trained coach would appear to be an antidote.

The good news is that managing weight in children who are heavy may be easier than expected. Another study suggests that use of a powdered prebiotic fiber could reduce weight gain in children by improving healthy gut bacteria and digestion. The fiber used in the study is oligofructose-enriched inulin.

“Powdered fiber, mixed in a water bottle, taken once a day is all we asked the children to change, and we got, what we consider, some pretty exciting results — it has been fantastic,” added Raylene A. Reimer, PhD, RD, professor and researcher in the Faculty of Kinesiology at University of Calgary, who led the study. (3)

Using an experimental design with a test and control group, the prebiotic fiber (taken mixed with water) appeared to cut weight gain among growing children by almost 2/3 (6.6 lb  gain among those using the prebiotic v. 17.6 in the control group).

Note: a prebiotic facilitates growth of good bacteria in the gut. A probiotic introduces new bacteria. They’re quite different and should not be confused.


Sources:

  1. Kayla de la Haye, Jan Kornelis Dijkstra, Miranda J. Lubbers, Loes van Rijsewijk, Ronald Stolk. The dual role of friendship and antipathy relations in the marginalization of overweight children in their peer networks: The TRAILS Study. PLOS ONE, 2017; 12 (6): e0178130 DOI: 10.1371/journal.pone.0178130
  2. Crain, “Childhood Weight, Adult Depression and . . . Bullying? Time to Connect the Dots?” May 2017.
  3. Alissa C. Nicolucci, Megan P. Hume, Inés Martínez, Shyamchand Mayengbam, Jens Walter, Raylene A. Reimer. Prebiotic Reduces Body Fat and Alters Intestinal Microbiota in Children With Overweight or Obesity. Gastroenterology, 2017; DOI: 10.1053/j.gastro.2017.05.055

Babies, Metals and Autism

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A new study from NIH indicates that children with autism and more lead and less magnesium and zinc than do children without the disease. Further, using a laser approach to assess growth rings in teeth, the exposure to lead might be before birth.

What we don’t know is whether absorption of lead and lack of absorption of the other metals is due to how the child’s body processes these metals or due to simple exposure.

However, the findings suggest that pregnant women should avoid exposure to lead (a major source of which remains paint in older homes and buildings)

The findings also shifts some attention away from vaccines, as exposure to lead in the womb is well before the child is vaccinated.


Sources:

  1. National Institutes of Health, “Baby teeth link autism and heavy metals, NIH study suggests,” Press release, 1 June 2017.

ACA Repeal: Update

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I’ve been quiet about the recent AHCA legislation. Frankly, the House bill isn’t good for ben_franklinmost Americans, but the assumption is that the Senate will heavily revise the bill before it has a chance for passage. So it’s hard to say what the final legislation will be at this point.

Then it goes to conference committee and the result will return to each chamber for a vote.  So this is a long way from being done.

There are a number of articles enumerating the problems in the House bill. The major issues are

  • Loss of health insurance for millions of Americans
  • Impact on the solvency of hospitals and clinics serving rural areas — where most of the poor live
  • Reductions in Medicaid coverage, especially for children
  • Allowing states to reduce coverage standards in insurance (depart from the ACA’s Minimum Essential standards) — reducing what the insurance buyer gets for their money
  • Raising costs drastically for consumers between the ages of 50 and 64 (1)

With all of these issues, we are still expecting the repeal bill to result in sharply higher premiums for health insurance.

The only positives in this bill are tax reductions for the wealthy.

My major concern is with health screening and checkups. The ACA recognized that the main way to reduce health care expenditures is through early detection and treatment of disease. Removing access to doctors means later detection and much higher costs.

Example: breast cancer, cost of treatment by tumor stage

Stage

0                                         $71,909

I/II                                      $97,066

III                                      $159,442

IV                                      $182,655 (2)

Reduction is access to health care is a commitment to higher medical spending or to reduction of life expectancy.


Sources:

  1. Harris Meyer, “15 quick facts from CBO report on Obamacare repeal bill,” Modern Healthcare, 24 May 2017. http://www.modernhealthcare.com/article/20170524/NEWS/170529946?utm_source=modernhealthcare&utm_medium=email&utm_content=20170524-NEWS-170529946&utm_campaign=mh-alert
  2. Helen Blumen, Kathryn Fitch, Vincent Polkus, “Comparison of Treatment Costs for Breast Cancer, by Tumor Stage and Type of Service,” Am Health Drug Benefits. 2016 Feb; 9(1): 23–32.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4822976/

Childhood Weight, Adult Depression and . . . Bullying? Time to Connect the Dots?

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Being narrow-minded affects people in a broad range of occupations, including ben_franklinacademia. Most people working in one field don’t see what people in related field are doing. Truth literally “falls between the cracks” separating different areas of work.

The people to whom we ascribe brilliance, like Steve Jobs, are those who are able to gather information from a broad array of sources and disciplines and connect the dots to form a coherent picture that others can’t see. Others fail to see the same because they don’t look. They limit what they see to the portion of the world in which they live and work.

Now for an example . . .

In an earlier blog, I reported on research linking being a victim of bullying to depression and health issues in high school. (1) The theory is that the impact of bullying can last well into adulthood.

A new study by Deborah Gibson-Smith from VU University Medical Center in the Netherlands and colleagues reports on a link between being overweight as a child and adult depression. The study doesn’t explain how extra pounds as a child effect adult emotions; it simply reports a statistical relationship. (2) The premise is that it has something to do with self-image.

My theory: Overweight children get bullied, and that bullying causes negative attitudes and behaviors that can linger into adulthood. It’s a simple idea, testable, and provides a concrete mechanism for converting excess weight as a child into adult depression.

However, because we have one group studying the effects of weight, and a different group studying the effects of bullying, apparently no researchers have tried to connect these dots.

Does that make sense?


Sources:

  1. Crain, “Bullying and Depression.”
  2. European Association for the Study of Obesity. “Being overweight in childhood may heighten lifetime risk of depression.” ScienceDaily. ScienceDaily, 18 May 2017. <www.sciencedaily.com/releases/2017/05/170518221006.htm>.

 

 

Lyme Disease

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Lyme effects animals as well as people. The range of the disease has expanded to cover most of the US, although the hot spots for it remain the Northeast and Upper Midwest.

The number of cases is expected to increase this year beyond levels seen in the past. The map below shows the veterinarian’s view of the risk, which is fairly similar to the CDC view for people. Same virus, same ticks.

We saw a mother allow her toddler to crawl through grass next to an ice cream stand in NJ today. That used to be an innocent behavior. Now I just hope she checks the child carefully for ticks.

20170410-CAPC-Forecast-Maps-Display-v4-Lyme.jpg


Sources:

  1. Michael Yabsley, “Heartworm disease and Lyme disease are forecasted to be highly problematic in 2017,” Companion Animal Parasite Council (CAPC). https://www.capcvet.org/articles/heartworm-disease-and-lyme-disease-are-forecasted-to-be-highly-problematic-in-2017/