Even known food allergens dangerous for kids

Even when parents and caregivers are aware of infants' food allergies and have been instructed in avoiding potentially dangerous trigger foods, allergic reactions still occur, the result of both accidental and non-accidental exposures, a study finds.

Accidental exposures from unintentional ingestion, label-reading errors and cross-contamination resulted in 87% of 834 allergic reactions to milk, eggs or peanuts in the study, reported in today's Pediatrics.

Non-accidental exposures resulted in 13% of reactions. It's not clear why caregivers would purposely give a child a known allergen, maybe "to see if (the child) has outgrown an allergy, or how allergic he is," says lead author David Fleischer, a pediatric allergist at National Jewish Health in Denver.

Fleischer and colleagues analyzed data from 512 infants, ages 3 months to 15 months, diagnosed with or at risk for having an allergy to milk, eggs or peanuts. In a 36-month period, 72% had at least one reaction; 53% had more than one.

"This is a high rate of reactions and concerning," says Fleischer, noting that parents were counseled "on a regular basis about food avoidance."

Only 50% of the accidental reactions were from food provided by parents, highlighting the importance of educating all caregivers � grandparents, siblings, babysitters and teachers � about food allergies, he says.

"There is still some misunderstanding in the general public about food allergy and how serious it can be," says Ruchi Gupta, an associate professor of pediatrics at Northwestern University. She led a study published last year that found 8% of U.S. children younger than 18 have a food allergy. About 40% had experienced a life-threatening reaction, such as blocked airways or a drop in blood pressure.

Concerns that skin contact or inhalation might trigger severe reactions were not supported by the new study, Fleischer says. "The vast majority happened from ingestion."

Only 30% of severe allergic reactions were appropriately treated with an epinephrine injection, even when caregivers said they felt that was warranted. Epinephrine helps stop reactions by relaxing muscles in the airways and tightening blood vessels.

There's often a "fear of using epinephrine, a concern that there will be side effects," Fleischer says. "In studies that we've done, parents are surprised how quickly and effectively it works."

Can SEIU Help Vermonters Win Single Payer?

While the nation waits for an overdue Supreme Court decision that will decide the fate of President Obama�s Affordable Care Act, another health care drama with wide implications for universal health care is just starting in Vermont.

Prodded by a strong grassroots movement, the Vermont legislature voted last year for a single-payer state health care system where every citizen will eventually be eligible for publicly funded health care.

The new system will take five or six years to fund and implement, however, between phasing out existing insurance arrangements, overcoming legal obstacles, dealing with provisions of the Affordable Care Act, and finding the money to pay for it all.

Meanwhile, the local business community, private insurance companies, and right-wing PACs have regrouped and counterattacked, with non-stop advertising. They�re doing their well-funded best to make sure that single payer never happens in this state or any other. They know that a lot can change, politically and in the state budget, between now and final implementation of Vermont�s health care law, particularly in a state with two-year gubernatorial terms.

Business-Backed Counterattack

Last year�s overhaul was backed by Governor Peter Shumlin, a multimillionaire businessman who faces re-election this year after narrowly winning office in 2010.

Single payer continues to poll well in the state, despite its lack of concrete benefits for even one Vermonter so far�a weakness that conservative opponents are exploiting in their campaign of disinformation and fear-mongering. A recent poll conducted by several Vermont media found nearly 48 percent of those surveyed still favor single payer; 36 percent are opposed.

Shumlin is likely to defeat GOP candidate Randy Brock, whose top adviser is Darcie Johnston, founder of Vermonters for Health Care Freedom, a key conduit for anti-single-payer propaganda, financed by business.

But even if Brock and fellow Shumlin critic Wendy Wilton, who is running for state treasurer, lose this fall, progressives fear they will spread doubt about reform. As a centerpiece of her campaign, Wilton predicts that Vermont will be running budget deficits above $2 billion by 2018 if �Green Mountain Care� becomes a reality. Right-wingers also warn about the new taxes everyone will be required to pay.

�Air War� for Single Payer?

To counter conservative attacks, Shumlin and friends will soon unveil �Vermont Leads: Single Payer Now!,� their own vehicle for advertising and door-to-door canvassing in favor of Green Mountain Care. This new addition to the existing constellation of health care reform groups will spend more than $100,000 on a six-month drive �to engage and activate Vermonters through media and grassroots organizing.�

According to Peter Sterling, an experienced local political operative who was just named director of the group, �more is expected in 2013 for TV ads,� when the legislature reconvenes.

Unfortunately, Vermont Leads doesn�t draw on the formidable grassroots network created since 2008 by the Vermont Workers� Center�and seems designed to bypass the group, which is the state�s most influential single-payer advocate. The VWC�s �Health Care Is a Human Right� Campaign has been widely credited, both locally and nationally, with spearheading the multi-year community-labor mobilization needed to pass the legislation last year.

While working closely with Shumlin and key Democratic legislators to achieve that goal, the Workers� Center has also been willing to sound the alarm and swarm the statehouse when things got off track. Last May, for example, VWC organizers brought more than 1,500 Vermonters to the Capitol to thwart a bid by legislative insiders to exclude undocumented workers from the scope of the law.

The VWC has long received strong backing from unions with members who live and work in Vermont�like the United Electrical Workers, Communications Workers, and Vermont Federation of Nurses and Health Professionals, which bargains for most unionized health care workers in the state.

In contrast, Vermont Leads is being funded by just one union�the 1.9 million-member Service Employees, which has no members working in the state and failed to affiliate the still-independent Vermont State Employees Association more than a decade ago.

�Working with People Who Have Money!�

For Vermont Leads� volunteer board members, SEIU�s sudden arrival, with a wad of cash large by local standards, is cause for some rejoicing. One new recruit is former state AFL-CIO President Jill Charbonneau, a postal worker, who noted in an email to friends that she was �not used to working with people who have money!�

Another Vermont Leads enthusiast is Middlebury College anthropology professor Ellen Oxfeld, who has campaigned under the banner of a small group known as Vermont for Single Payer. SEIU funding is �a gift from heaven,� she told me. �We want to combat the lies, keep up the momentum for single payer, and organize around the financing package� to be adopted by legislators next year.

Deb Richter, leader of Physicians for a National Health Program in Vermont, gave similar reasons for joining Vermont Leads. �We�ve got six more years of fighting to do to keep this on track,� she said. �We now have the ability to spend more for ad campaigns and literature drops. Instead of using existing groups, it made sense to have this one be a separate entity.�

As for SEIU, �they�ve always been single-payer supporters,� Richter asserted. �That�s what I�ve been told.�

Looking a Gift Horse in the Mouth?

Others in single-payer circles wonder whether this particular gift horse could become a Trojan horse that will weaken Vermont�s movement for health care as a human right.

SEIU�s sudden appearance in the state is worrisome to union friends and political allies of the VWC, now in the middle of its own fundraising drive to support an energetic staff of eight who coordinate the work of scores of volunteers around the state.

The VWC is enlisting nationally known figures for a public statement of support titled �Vermont Can Lead the Way.� In an open letter soliciting 1,000 such endorsers, VWC leaders argue that �we will never be able to outspend giant healthcare profiteers and other big money groups in an �air war.� But we can out-organize them on the ground!�

SEIU�s lack of any members on the ground, plus its unhelpful role nationally in health care reform from the Clinton to the Obama eras, has led some labor activists to question its motivation for becoming a single-payer sugar daddy, virtually overnight.

One explanation involves SEIU�s competition with AFSCME to represent personal care attendants in Vermont. Neither union can gain 5,000 new members in that workforce without Shumlin and the legislature agreeing to create a new homecare bargaining unit, plus some sort of card check or election mechanism for union recognition by the state.

And if Shumlin, in the meantime, needs to do some back-pedaling on single payer�under pressure from business interests�SEIU could easily provide political cover for him, local activists fear. For the union, the quid pro quo would be the governor favoring SEIU over AFSCME to represent homecare workers.

Bad Record Elsewhere

Elsewhere in the U.S. and at the federal level, SEIU has undercut other unions� attempts at single-payer legislation (even though its own affiliates have passed many pro-single payer resolutions over the years).

In California, SEIU lobbied against other unions� attempts for single-payer legislation. Then-SEIU President Andy Stern cooked up a plan with Governor Arnold Schwarzenegger that would have required all Californians to buy private insurance but didn�t control the cost of that insurance and set no minimum standards for coverage. Included in the bill was a fund for homecare workers’ health benefits�to be administered by SEIU.

�SEIU played the leading advocacy role and ultimately the lead compromise role on that bill,� California Nurses Association staffer Michael Lighty recalled. “Stern went behind the back of the California State Fed to cut the deal. But it didn’t even pass in the state senate. It lost the backing of labor. It could not withstand the scrutiny.�

In Massachusetts, SEIU affiliates have done little or nothing to build Mass-Care, the main single-payer advocacy organization. Instead, the union worked with Ted Kennedy, then-Governor Mitt Romney, and the coalition known as Health Care for All to enact the state system of mandated private insurance that became the model for the Affordable Care Act.

As one labor friend of Mass-Care notes, �SEIU has been completely absorbed with Romneycare. For them, it�s all about hospital financing, never about changing the system itself.�

Similarly, SEIU helped run interference for the Obama administration when it was working to keep single payer�and ultimately, any public option�off the table in 2009-2010.

Working with liberal foundations and other labor groups, SEIU helped raise $40 million for a group called Health Care for America Now. As David Moberg from In These Times reported, HCAN�s spending swamped that of single-payer groups, while �promoting a strategy closer to Obama’s proposal that would include employer-provided or individually purchased private insurance.�

In 2009, SEIU operatives even intervened at community forums in New Hampshire held to discuss the Affordable Care Act: they tried to prevent local PNHP supporters from distributing pamphlets on single payer.

SEIU�s Man with a Plan

Further fueling suspicions about SEIU�s intentions in Vermont are the multiple hats worn by recently arrived national staffer Matt McDonald. His past assignments have included trying to keep 45,000 Kaiser Permanente hospital workers from fleeing SEIU in California and joining the National Union of Healthcare Workers. In 2010, McDonald was part of an organizing team that engaged in so much misconduct that the National Labor Relations Board overturned the results of that election.

McDonald set up Vermont Leads from scratch, made himself a board member, and hired Sterling as its director. Meanwhile, he is also masterminding SEIU�s attempt to create the new statewide bargaining unit for personal care attendants, an effort that wisely includes wooing advocates for the elderly and disabled who receive such services. (For details on AFSCME�s homecare worker organizing in Vermont, which started before SEIU arrived, see here.)

In response to an email seeking details on SEIU�s homecare organizing plans and the about-to-be-unveiled Vermont Leads, McDonald replied that the questions �threaten the dual goals of creating a single payer system here in Vt., and the eventual unionization of thousands of workers.�

Scramble for New Members

A slugfest between SEIU and AFSCME in Vermont would be a throwback to the frenzied spending contests waged by the same two unions over home-based workers in 2004-2005. In the process of obtaining �organizing rights� deals in Illinois for both childcare and homecare workers�and prevailing over AFSCME there�SEIU became labor�s biggest funder of Rod Blagojevich, the Democratic governor whose illegal �pay to play� schemes landed him in jail for 14 years.

As similar homecare or childcare units unravel in several states under hostile GOP governors, SEIU is now increasingly desperate for new members. A union that was growing by 100,000 annually in 2006-2008 has hit the wall, due to external enemies and its own internal dysfunction.

In 2011, SEIU registered a net gain of only 7,000 members and agency fee-payers, as compared to 59,000 the previous year. So 5,000 new dues payers in Vermont have become a more tempting prize than before, even if they require a costly brawl with an AFL-CIO union that already represents other public workers in the state.

For budgetary reasons, Vermont�s Democratic-controlled legislature balked at creating a new statewide bargaining unit for publicly funded day care providers earlier this year. This was a major, but hopefully not permanent, setback for the Teachers (AFT), the state�s largest AFL-CIO union.

But Shumlin�s passive role and the opposition of key Democratic legislators doesn�t bode well for AFSCME or SEIU doing much better in homecare, as long as the two unions remain divided.

Price of a Relationship

The prospect of a homecare union war is not appealing to others in Vermont labor, for multiple reasons.

�In my opinion, SEIU seems to be cultivating a direct relationship with our governor by loyally supporting his health care plan�including all the expected compromises and retreats that may lie ahead,� says Traven Leyshon, secretary-treasurer of the Vermont AFL-CIO. �This will create real problems for any of us pushing for a stronger, more progressively financed single-payer system than Shumlin favors.�

Ellen David Friedman, a founder of the Vermont Progressive Party and past organizer for the National Education Association in the state, agrees. �SEIU makes very short-term and opportunistic calculations,� David Friedman said. �They will help Shumlin get re-elected in exchange for legislation authorizing homecare unionization. My guess is that his position on single payer really doesn�t matter much to them, since they�ve never really fought for it anywhere else.�

State Senator Anthony Pollina, a Progressive Party leader, worries that the wrong kind of pro-single payer �air war,� funded and directed from out of state, may �encourage right-wing groups to come in and spend even more money.�

According to Pollina, �things could escalate into a media campaign that leaves citizens on the sidelines, just like past single-payer referendum campaigns that were lost in Oregon or California.� Like the Workers� Center, he believes that �progressive grassroots activists can �out-organize� the opposition on the ground but SEIU�s invasion could end up undermining this good work.�

Richter and Oxfeld both insisted they would never let this happen while they served as Vermont Leads board members. �Vermont is a small place,� Richter said. �If it turns out SEIU is trying to push us in a different direction, they won�t have the ground troops to pull it off.� According to Oxfeld, �if they really try to get in the way, I don�t see anyone on the board going along with it.�

Health Care History Repeats?

Three years ago, Michael Lighty from the CNA predicted that creation of a publicly funded model plan, providing universal coverage in an American state, would �move us closer to a single-payer solution� than the �public option� that labor wanted in the Affordable Care Act until President Obama nixed it.

But Lighty warned that �if you pass a plan that�s watered down and bad, you�ve squandered the political moment. You�re going to fuel the cynicism and distrust so many people already have in what can be accomplished in Washington.�

Health care reformers in Vermont are concerned that SEIU will eventually play the same role locally that it did nationally in 2009-2010. If that results in another squandered political moment�this time leaving Vermonters cynical and distrustful about what can be accomplished in Montpelier�the repercussions will be felt in every other state capital where progressives still hope to improve on the Affordable Care Act.

Steve Early is a labor journalist who started writing about Vermont politics when he was a Middlebury College student in 1968. He spent three decades as a New England representative for the Communications Workers, assisting members in Vermont and other states with strikes, contract negotiations, organizing, and health care reform activity. He is the author, most recently, of The Civil Wars in U.S. Labor, from Haymarket Books, and a longtime supporter of the Vermont Workers� Center.

Carol-Care and Justin-Care: Extending Coverage on a Parent’s Health Plan

Carol Metcalf�s son, Justin, has a rare genetic lung disease, primary ciliary dyskinesia, but while he needs medical care for it, he hasn�t let the disease define him. He�s thinking about going to law school, or possibly graduate school in international studies. Justin, 23, is able to do so because of the health care law, Carol says.

Because of the Affordable Care Act, young adults like Justin can remain on their parents� health insurance plan until their 26th birthday, even if they move away from home or graduate from school. More than 3 million young adults have gained health insurance because of the health care law.

That has made a tremendous difference in their lives and for their parents� peace of mind.

�As Justin�s Mom, you know every mom wants the best for her child and you want them to have a fair shot � a good shot at life and to be able to make their own way and to be able to pursue their dreams,� Carol says. �The Affordable Care Act gives people like Justin that opportunity.�

Justin explains that if it wasn�t for the health care law, all his energies would have to go into worrying about how to get health care at a cost he could afford. Because of his condition and expensive medical bills, living without coverage isn�t an option. Being able to stay on his parents� plan ensures that Justin is covered and can make his choices based on more than his lung disease.

Without it, Justin says that considering law school wouldn�t even be possible.

�I would have to find medical care right away, because medical care comes first. Without medical care, I�m not here. It�s really that simple,� he says.

And knowing that Justin can stay covered by the family�s health plan for a few more years, Carol says, �is a huge peace of mind.�

Senate negotiations may drop healthcare IT grant funding from $5B to $3B

WASHINGTON – Senate wrangling over the weekend on a proposed $900 billion economic stimulus package has led to a $3 billion cut in proposed healthcare IT discretionary funding.

The Senate had been looking at spending $22 billion to $23 billion for healthcare information technology in the economic recovery package – including $5 billion originally allotted for funding that could include grants for providers to purchase healthcare IT.

Over the weekend, however, $2 billion was cut for healthcare IT federal discretionary funding.

The Senate says it may have the three Republican votes needed to pass its version of the stimulus package, but insiders say negotiations will be fierce before an expected final vote on Tuesday – and chances for passage may lessen the longer a vote is postponed.

Republican Sens. Susan Collins and Olympia J. Snowe of Maine and Arlen Specter of Pennsylvania have indicated they are likely to support the trimmed version of the Senate stimulus package, according to (italics) CQ Daily. (end italics)

Healthcare IT privacy activists are lobbying hard for privacy measures to be included in the package. "Privacy and security protections have to be meaningful and comprehensive or electronic health systems will never be trusted," said Deborah Peel, founder of Patient Privacy Rights.

Once the Senate passes its version of a stimulus package, it must be reconciled with the House version before it can be signed into law.

President Barack Obama hopes to have a bill passed before Feb. 13.

How Opponents Won The Health Care Messaging War

OK, so it's not exactly news that the Obama administration hasn't done the best job in the world selling the Affordable Care Act to the American public.

But now the Pew Research Center's Project for Excellence in Journalism has some statistics to demonstrate just how sorry that job has been. And it suggests that the media gets at least some of the blame.

It seems that during the pivotal period during which the legislation was being crafted (and the public was forming an opinion), from June 1, 2009, through March 31, 2010, nearly half the media coverage (49 percent) "focused on politics and strategy as well as the legislative process." How much focused on what the measure would actually do? Just 23 percent.

The study also measured how often media reports mentioned terms used by opponents of the bill, such as "government-run," or "rationing health care," compared to those used by supporters, such as "pre-existing conditions" or "more competition." It found that terms used by opponents "were far more present in media reports than terms associated with arguments supporting the bill."

Despite the success of opponents in messaging, however, the public remains largely split over the law, with most polls showing a majority of Democrats supporting it, and a somewhat larger majority of Republicans opposing it.

First lady walks fine line on NYC drink proposal

WASHINGTON(AP)�First lady Michelle Obama says banning big servings of sugary drinks isn't anything she'd want to do at the federal level, but she offered some kind words Tuesday for New York Mayor Michael Bloomberg's effort to do just that. She later issued a statement backing away from taking a stand on New York's controversial proposed ban.

It was a telling example of the fine line the first lady walks as she tries to improve Americans' health and eating habits without provoking complaints that she's part of any "nanny state" telling people how to eat or raise their children.

Asked about Bloomberg's proposal during an interview with The Associated Press, Mrs. Obama said there's no "one-size-fits-all" solution for the country's health challenges. But she said, "We applaud anyone who's stepping up to think about what changes work in their communities. New York is one example."

And asked whether the nation's obesity epidemic warrants taking a more aggressive approach, such as Bloomberg's, she said: "There are people like Mayor Bloomberg who are, and that is perfectly fine."

Mrs. Obama later issued a statement saying that she hadn't intended to weigh in on the Bloomberg plan "one way or the other."

"I was trying to make the point that every community is different and every solution is different and that I applaud local leaders including mayors, business leaders, parents, etc., who are taking this issue seriously and working towards solving this problem."

"But this is not something the administration is pursuing at a federal level and not something I'm specifically endorsing or condemning."

In the interview, Mrs. Obama said she's "trying to create a big tent for people. Our motto is everyone has a role to play in this and I think it's up to communities and families to figure out what role they can play, what role they should play."

Last week, Bloomberg proposed limiting portion sizes of sugary drinks to 16 ounces at the city's restaurants, delis, food trucks, movie theaters and sporting arenas. Regular soda and sports drinks would be affected but not diet sodas.

The proposal is unpopular with most New Yorkers, according to a NY1-Marist poll conducted Sunday. A majority of New York City residents said the proposal was a bad idea and 53 percent said it was more government going too far than good health policy to fight the problem of obesity. The ban is expected to win the approval of the Bloomberg-appointed Board of Health and take effect as early as March.

Mrs. Obama spoke about the Bloomberg plan during an interview promoting her new book, "American Grown: The Story of the White House Kitchen Garden and Gardens Across America." The $30 book, which came out last week, traces the story of the garden on the South Lawn and of gardens around the country as the starting point for a national conversation "about the food we eat, the lives we lead, and how all of that affects our children," as Mrs. Obama puts it.

The first lady, wearing a print dress and periwinkle cardigan, enthused over green peppers coming into their own and a fig plant that's finally standing tall after a perilous infancy as she offered a walking tour of the garden. She ducked under some evergreens to point out a row of logs nailed to a post that will soon be sprouting shitake mushrooms.

Then, seated at a picnic table dressed up with a yellow checkered tablecloth, the first lady spoke of the progress that's been made in offering people healthier food choices and better nutrition information.

Mrs. Obama had just come from an appearance with Disney executives, where the company announced it would become the first major media company to ban junk food ads from its TV channels, radio stations and websites intended for children, starting in 2015.

Later in the day, she was scheduled to present a garden-related Top 10 list on CBS' "Late Show With David Letterman."

An example from her list, according to a CBS preview: "No. 7: In his lifetime, the average American will eat half a radish," she said, speaking from the White House Map Room.

And next Tuesday, she'll do a book signing at a Barnes & Noble in Washington � for a limited number of customers who buy a book this week and get a special wristband.

It's all part of the first lady's all-out effort to combat childhood obesity without provoking a backlash by pushing too hard. Mrs. Obama's high favorability ratings show she's largely been able to strike the right tone, a boon to her husband's re-election effort. But there is still sniping from some on the right who say they don't need a government lecture � or more intrusive steps � on what they eat or how they exercise.

Asked if she ever has to bite her tongue at Obama critics � legion in an election year � the first lady batted away the idea, saying she stays away from "all the chatter and the noise."

"It's not a difficult thing for me to do because we've got so much good stuff to talk about � like this book and the garden and getting our kids healthy and active," she said.

Mrs. Obama spoke of the enthusiastic response the garden has elicited from kids all over the country � but not so much from her own daughters.

"You know, they are not interested in gardening," she said. "I think it has a lot to do with the fact that I'm their mother and this is my interest, and they go in the opposite direction."

Author fears for future of the American breast

The American breast is bigger than ever before.

And breasts are developing in girls earlier than at any time in recorded history.

But do breasts have a future?

The biology of the breast is changing � and not for the better, says journalist Florence Williams, author of the new book Breasts: A Natural and Unnatural History (W.W. Norton & Co., $25.95).

She details a number of alarming trends that may be contributing to the USA's high rate of breast cancer � today and in years to come.

Women's breasts are expanding with their waistlines, Williams says. The average bra size has grown from a 34B to a 36C in just a generation. That's troubling, given that weight gain has been associated with an increased risk of postmenopausal breast cancer.

Girls also are hitting puberty earlier than ever before � another trend that increases their long-term breast cancer risk. About 15% of all American girls begin developing breasts at age 7, according to an influential 2010 study in Pediatrics.

Breasts today also are under assault from pollutants, Williams says. Because chemicals such as PCBs and mercury are stored in fatty tissue, they tend to end up in breasts � and breast milk. "Breast-feeding, it turns out, is a very efficient way to transfer our society's industrial flotsam to the next generation," Williams writes. "Our breasts soak up pollution. � Breasts carry the burden of the mistakes we have made."

While nursing her second child, Williams had a sample of her own milk analyzed. It contained perchlorate, an ingredient in jet fuel, as well as chemical flame retardants, at levels 10 to 100 times higher than in European women. Williams says she believes in breast-feeding, and she spends considerable time in her book noting its benefits for a baby's brain, body and immune system.

But she notes that many industrial toxins will persist in our bodies � and our children's bodies � for years, long enough for today's baby girls to pass them on to their own children.

"What happens in our environment is reflected in our breasts," she says. "If we really care about human health, we need to care about our planet."

Surprisingly, doctors stand to learn a great deal about the environment's effect on the breast by studying men, Williams says.

Marine Pfc. Joe Glowacki was exposed to a wide variety of chemicals when he arrived at Camp Lejeune, N.C., in 1959, at age 17. At the time, the Marine Corps didn't realize the danger of allowing petroleum and other chemicals to pollute the groundwater. The base is now home to dozens of Superfund cleanup sites, and at one point Camp Lejeune had the "most contaminated drinking water supply ever discovered in the United States," Williams writes.

Three years ago, Glowacki found a lump on the right side of his chest. "The next thing you know, I'm one of the girls," says Glowacki, now 70, of Medford, N.J. Glowacki was diagnosed with breast cancer and had a mastectomy and chemotherapy. About 2,190 of the 229,060 breast cancers diagnosed in the USA each year are in men, according to the American Cancer Society. More than 70 have been diagnosed in men who have lived at Camp Lejeune, Williams writes.

"In 1957, who knew all of this?" Glowacki writes. "We disposed of our excesses by pouring them down the drain."

Everyone Wants Healthcare Reform

Written by Timothy Fisher

I spent much of Election Day at the polls helping collect signatures to support a single-payer health care initiative. Given the great turnout for this year�s election, this was an excellent way to get a sense of who really lives in one�s town. In this increasingly polarized world, it�s probably the one event where almost everybody shows up. Left and right, young and old, working, retired, students and families all in one place and all strolling by my little table. Many did that exactly, strolling right on by without any interest in signing anything for anybody. But of those who chose to stop, the interest in this issue was profound.

We all know that the skyrocketing cost of health care is a problem all over the country. But until you spend a day talking with folks from all walks of life about their own experiences, it�s hard for it to really sink in. It truly seemed that everybody is fed up with the health care system we have now. Of course there were those who believe that easy access to health care ought to be the right of every American, rather than the privilege it is increasingly becoming today. They all signed this petition. But they were hardly alone. There were people who were just plain sick of paying gobs of money for a high-deductible plan and then still paying all of their medical bills anyway. There were people paying more for these �catastrophic coverage� plans than the mortgage on their home. Many signed who were only holding onto a job for fear of losing the insurance. This was especially scary for one woman who wished to retire but needed her company�s plan to support her husband�s medical needs. There was an Iraq war veteran who felt well cared for by the military, but was frustrated to watch his young adult daughter unable to afford her own coverage.

More than a few signed who didn�t like the idea of tax-supported health care, but thought that �we just have to do something!� Everybody sees the need for change. And everyone has some horror story about their own family or friends who battled the insurance company to fulfill their promises or ER visits that break their budgets or having to choose between food, fuel or medicine. People are so desperate for help.

Pretty much everyone under age 50 signed my paper, as did anyone with a kid attached to their leg. Maine is a place where many people work for themselves and they especially are being left behind by today�s system. Carpenters, plumbers, artists, store owners, farmers and pretty much every fisherman signed this paper. None of these people wants more taxes, but more importantly, I think all these people want to feel they�re getting something back from paying those taxes. In the last few years we�ve watched in dismay as our leaders dish out billions upon billions to fund a war far away from home, and then to bail out the rich on Wall Street. Now there�s talk of bailing out the auto industry because they had a serious lack of foresight. It�s not too big a stretch to imagine us soon bailing out the health insurance companies. As premium costs rise, more people and businesses will drop their plans, thereby making the costs rise yet again. The whole industry is on a path to failure. We need to change it now before that happens. We need to change it in a way that supports the people rather than the corporate world. As our new president, Barack Obama will have many of the pieces in place to make real change in our health care system and he appears to have the desire to do so. But his current ideas are marginal at best. He needs to be pressed right now on what the people want this system to be. If it�s not working out for you, write or call your representatives and tell them what you want the American health care system to be.

Anyone interested in more information can check out: www.midcoasthealthcarereform.org.

Thank you to those who helped collect signatures last week, and also to everyone who signed this petition and even to those who did not sign but took the time to stop and discuss this crisis.

Timothy Fisher is a resident of Prospect Harbor.

Virginia-Care: Keeping Health Insurance Costs Down for a Small Businesses

Virginia Donohue and her husband started Pet Camp in 1997 with a love of their dogs and little else. Located in San Francisco, California, they provided group play, open spaces, and a pool. Cats had disco lights to play with, aquariums to watch and wide window sills for perches. When the business became sustainable in 2000, Virginia says, it was time to provide health insurance to their employees.

�To me it�s a moral issue. People need to have health care and how we get it is through work,� she says. �I have been one of the employers out there saying, �Look, offering health care is important.��

Virginia says that when she heard about the health care tax credit for small businesses available under the Affordable Care Act, �I was really excited.�

The health care law�s tax credit for small businesses is making it more affordable for Virginia�s company offer health coverage to its employees. She uses the funds from the tax credit to offset the company�s insurance costs. The health care tax credit, she says, amounted to about $7,000 in 2010 and about $8,000 for 2011.

The tax credit is also helping her company stay competitive in the marketplace for good employees.

�We offer health insurance because we want to attract and retain the best employees that are out there, and I think to do that you have to offer quality benefits. � [F]or us, that includes health insurance � that includes bring[ing] your dog to work,� Virginia says.

2012 elections aren’t just about health reform

Harold Pollack and Henry Aaron: GOP health and budget plans would crack pillars of income security for poor and middle-class Americans.

Two years ago, long-frustrated advocates of national health reform rejoiced as Congress passed the Affordable Care Act�(ACA). Before the act was even signed, opponents began a campaign they described as ‘repeal and replace.' This label, it is now clear, is misleading.

There is no agreed ‘replacement' program. "Repeal" would kill expanded coverage for roughly 32 million low- and moderate-income Americans.

There is, however, a GOP program that goes beyond that, to roll back other health protections and roll back federal government activity to levels not seen since the 1930s. Republicans' congressional leaders and their all-but-nominated presidential candidate embrace severe fiscal limits that would pretty much realize Grover Norquist's dream of shrinking the federal government "down to the size where we can drown it in the bathtub."

This program has three pillars, which together may be more important than health reform. Thus far, these pillars have received less scrutiny than they deserve.

Deep tax cuts + spending reductions

The first pillar includes deep tax cuts linked to a balanced budget requirement, a combination that requires massive spending reductions. The tax cuts include elimination of all taxes on long-term capital gains and on much interest and dividends, ending the estate tax, permanent extension of all Bush era tax cuts, and additional rate cuts of 20 percent.

Future spending cuts would be in addition to those Congress approved last year. That round of cuts exempted programs benefitting the poor. Future cuts would target programs benefitting the poor and middle class.

Medicaid cuts

Pillar number two is deep Medicaid cuts and the program's conversion into a block-grant. This policy is embodied in the House Republican Budget resolution, and is endorsed by the Romney campaign.

For five decades, the federal government matched every dollar states spend on Medicaid with one to five dollars. States are required to cover certain essential services for specific needy recipients. The attraction of federal matching funds leads most states to cover additional services such as adult dental care, and to cover additional populations within the ranks of the working poor. The federal match also helps states maintain coverage when recessions cut revenues while needs increase.

The Republicans' program would replace Medicaid's current financing with a fixed payment adjusted to grow more slowly than Medicaid has done. Had this approach been enacted in 2000, reports the Center on Budget and Policy Priorities, Medicaid spending in 2010 would have been 31 percent lower than it actually was. If enacted now, the House Budget committee plan would cut Medicaid expenditures ten years from now by about 34 percent.

Federal payments would not be slated to grow if the number of needy people grew, if the states covered additional services, or if the prices of services rose. Two-thirds of Medicaid spending now serves the elderly and the disabled. Inevitably, eligibility and service coverage would narrow for these groups, along with services to others in economic need.

Medicare voucher program

Pillar number three is the conversion of Medicare from a "defined benefit" to a "defined contribution" program. Medicare now pays for a specific package of medical services. House Republicans would replace this package with a voucher whose value would be tied an economic index, rather than to the actual cost of care. If medical costs outpaced the index, taxpayers would be off the hook, and Medicare beneficiaries would be stuck with the extra costs themselves.

Voucher proponents presume that Medicare enrollees would promote efficiency through aggressive shopping. Evidence for this presumption is sparse and speculative. ACA seeks increased efficiency through health care delivery innovations. While there is some basis for optimism, no one is entirely sure that this approach will work either. Who bears the risk if these costs are not brought under control? Under current law, the general tax payer and Medicare enrollees share that risk. Under the voucher plans, Medicare beneficiaries would shoulder it unaided.

Missing from this menu is any indication of how to deal with Social Security's projected funding gap. Republicans have made clear that they will oppose tax increases to close it. So the only things missing are the details on precisely how they propose to cut future Social Security benefits.

The agenda

The defining characteristics of this agenda are its regressivity and its shifting of cost and risk onto individuals, states, and localities that cannot bear the load. Taxes would go down, disproportionately, for the well-to-do. Spending would decline, disproportionately, for programs that serve the elderly, the disabled, and others in economic need.

This program could become law through the so-called reconciliation process, which requires only simple House and Senate majorities and is not subject to filibuster. Should Mitt Romney win the White House, Republicans would likely win control of the Senate and retain control of the House, bringing these majorities within grasp.

This legislative program is why the 2012 elections are the most important in living memory. Conservatives could achieve goals long in gestation and fervently sought. Liberals could see seventy-five years of social welfare legislation undone.

AMA thinking seriously about ICD-11

CHICAGO – ICD-10 proponents are not going to like this one bit.

Certainly not any more than they enjoyed my suggestion that the proposed ICD-10 deadline extension puts the U.S. healthcare industry into a strange time warp in which providers and payers will be finally implementing ICD-10 in the same one or two-year timeframe that ICD-11 is entering this world – and that being the case perhaps holding out for the 21st Century classification system that will be ICD-11, then moving aggressively to that is, well, at least worth considering.

Here it comes: The American Medical Association late Tuesday took up the ICD-11 cause.

Until now, it was a soft chant by rather disparate voices. If recent history with the proposed ICD-10 delay is any indication, though, the AMA can bellow loud enough to be heard in the highest of strongholds.

Potential alternative
The AMA voted on Tuesday to evaluate ICD-11 as a possible alternative to ICD-10 for replacing ICD-9 – saying that it will report back to delegates in 2013 with its findings.

“It is critical to evaluate alternatives to ICD-9 that will make for a less cumbersome transition and allow physicians to focus on their primary priority – patient care,” AMA president-elect Ardis Dee Hoven, MD, said in a statement. “The policy also asks stakeholders, such as the Centers for Medicare and Medicaid Services, to examine other options.”

Practicing the ‘it can’t hurt to ask’ methodology ostensibly worked for the AMA in getting ICD-10 delayed earlier this year. Two unrelated anonymous sources, both well-positioned vis a vis ICD-10, told me separately that even HHS Secretary Kathleen Sebelius was surprised when word came down – from the White House? – that her department was to postpone code set compliance. Take that as an unconfirmed rumor, please. But know that somebody, somewhere made the delay happen.

[See also: ICD-10 deadline do-over?.]

To be fair, the AMA could be in a time dimension all its own. HHS is likely to decide whether October 1, 2014 will be the new deadline, or not, well before 2013. Let’s hope. Unless HHS pushes ICD-10 further into the future, the AMA may be too late to start calling for ICD-11.

But the WHO in mid-May posted what it calls the beta drafting platform of ICD-11 – meaning work is underway though the process is undeniably nascent.

Not alone
The AMA is not the only one chanting for ICD-11. In a blind reader poll, Government Health IT asked its readers ‘Should the U.S. leapfrog ICD-10 and opt for ICD-11?’

Nearly one-quarter indicated “yes” while one-third weighed in with a firm “no.” Given the circumstances, which include the fact that ICD-11 is not yet ready for primetime, the more telling perspective is the 43 percent of a total 115 respondents who voted that “it’s worth considering.”

Matt Murray, MD, a pediatric emergency physician and self-described health IT advocate, contends in a May 17 blog post that CMS “prematurely dismisses the alternative option to forgo ICD-10 and implement ICD-11,” adding that he is “very concerned that this dismissal is published without a comparative analysis of the total costs of each option. And there is good reason to seriously consider implementing ICD-11.”

That’s a point very similar to one the MGMA has made – that before mandating ICD-10, CMS should conduct a comprehensive cost-benefit analysis, pilot ICD-10, and fully evaluate alternative approaches. Sounds only reasonable to me.

“Implementing ICD-10 has been compared to buying a Betamax instead of a VHS recorder in terms of pending obsolescence,” Dr. Murray wrote. “Informatics experts are in agreement that ICD-11 is superior to ICD-10 and that we need to get to it as soon as is tolerable.”

Continued next page.

Premier makes big connect with big data

CHARLOTTE, NC – The Premier healthcare alliance will connect more than 100,000 healthcare provides in what Premier calls the world’s largest healthcare community to share knowledge, data, best practices and decision support.

The alliance’s PremierConnect technology platform will make it possible for clinicians, supply chain leaders, hospital executives and other healthcare providers nationwide to connect as one in communities of common interest, officials say.

[See also: Premier to bring meaning to disparate data]

Premier, which describes itself as a performance improvement alliance, includes more than 2,600 U.S. hospitals and 84,000-plus other healthcare sites.

PremierConnect will connect data, knowledge and people in ways that support evolving care delivery models and accelerate the pace of performance improvement, say Premier officials. The virtual community allows alliance members to instantly share knowledge, data and strategies based on thousands of patient outcomes that can be used to benefit treatment anywhere, an ability that has been a missing link in care delivery to date.

"Health systems today need an integrated look into utilization, costs, efficiency and quality," said Michael D. Connelly, president and CEO of Catholic Health Partners. "With this information we can further build out the predictive capabilities that will help us find opportunities and enact corrective actions before they affect patients. This initiative is a critical foundational piece to our mission and the mission of the Premier alliance to improve the health of our communities."

[See also: Premier comparative effectiveness program seeking applicants]

PremierConnect supports new ways to deliver care that are required by health reform, including accountable care organizations (ACOs), which emphasize more clinical integration and healthier outcomes. Individual health systems can use it to connect care across all of their sites – hospitals, physician offices, outpatient clinics and more. These population analytic capabilities provide insight into how to manage populations for improved outcomes.

"Leaders of healthcare systems will be able to easily make data-driven, evidence-based decisions that improve performance while making their communities healthier places to live,” said Premier President and CEO Susan DeVore. “They'll know which patients are driving undesirable outcomes, which physicians have the highest costs or the poorest performance, and why these scenarios are occurring.

"Patients will have confidence that their care is based on proven innovations and best practices from top-performing clinical leaders nationwide," DeVore added. "And their providers will understand everything about their care – what drugs they're taking or allergic to, what procedures they've had recently and more."

PremierConnect will integrate Premier's clinical, financial and operational comparative databases, containing one in four patient admissions and close to $43 billion in annual purchasing data. This information is updated every 30 days to ensure it is current. It will also continuously integrate real-time electronic health record data from over 325 hospitals. Premier's quality, safety, labor and supply chain applications will be easily accessible in PremierConnect, helping providers make decisions based on a combination of quality, safety and cost information – not each individually.

"What we've built mirrors what we're trying to do in healthcare – build a system that is coordinated and integrated, where communication is dramatically improved and we aren't unnecessarily repeating work," said Keith J. Figlioli, Premier's senior vice president of healthcare informatics. "It will help eliminate unnecessary care that can compromise safety and add to already expensive bills for both consumers and health systems. It's a new, better approach to care delivery, with a truly efficient way to treat patients and keep people healthy."

PremierConnect is powered by IBM information management, business analytics, enterprise content management, social business, Rational, Tivoli and WebSphere software, as well as IBM Power Systems hardware to provide insights from vast amounts of data.

[See also: Premier develops industry IT standards for ACOs]

Local man spearheads statewide healthcare movement

ROCKLAND (Dec 8): Jerry Call is a man with a mission. Call, who lives in Rockland and is one of the five founders of Midcoast Healthcare Reform, first learned about single-payer health care about a year ago when Dennis Kucinich was running in the Democratic presidential primaries and mentioned House Resolution 676 during the debates.

“Finally it sunk in as to what he was proposing,” Call said Dec. 5. “After he was shut out of the debates, a bunch of us were sitting around at dinner and decided to do something about it.”

In January 2007, Congressman John Conyers introduced the current version of H.R. 676, which Kucinich referred to as the “Medicare for All” bill. Currently the bill is in the hands of the congressional Subcommittee On Health.

H.R. 676 would establish the U.S. National Health Insurance program to provide all residents of the United States and U.S. territories with free health care that includes all medically necessary care, such as primary care and prevention, prescription drugs, emergency care, and mental health services.

The law would allow nonprofit health maintenance organizations that deliver care in their own facilities to participate in the USNHI program and would give patients the freedom to choose from participating physicians and institutions.

Private health insurers would not be able to sell health insurance coverage that duplicates the benefits provided under H.R. 676, but would be allowed to sell benefits for care that is not medically necessary, such as coverage for cosmetic surgery or private hospital rooms.

Since January, Call has been traveling throughout Maine and beyond to promote Conyers’ bill. In March his organization coordinated showings of Michael Moore’s film “SiCKO” in seven locations throughout the state. MCHR maintains a mailing list of 250 interested parties in the local area and gathered more than 7,000 signatures at the polls statewide on Nov. 4.

The petitions Call is circulating ask the Maine Legislature to endorse the federal bill. While the resolution advanced by the petition is not binding on Maine’s elected officials, Call hopes a strong groundswell of support will encourage the federal delegation to sign onto H.R. 676.

So far, none of the state’s representatives in Washington, D.C. have joined the 93 congressional co-sponsors. In June the U.S. Conference of Mayors expressed its support of the bill and called upon federal legislators to work toward its enactment. And polls repeatedly show a majority of Americans supporting national health-care coverage.

In a letter to Call, Maine’s U.S. Sen. Susan Collins stated that she “continue[s] to have many reservations about a single payer system,” and that she instead supports S. 158, which would provide a tax credit of $1,000 to individuals earning up to $30,000 and $3,000 for those earning up to $60,000. According to the Web site smartmoney.com, private health insurance premiums cost upward of $4,000 a year for individuals and generally include co-pay requirements and high out-of-pocket deductibles.

Rep. Ed Mazurek of Rockland is sponsoring the single-payer resolution in the Maine Legislature, and Rep. Andrew O’Brien of Lincolnville has agreed to co-sponsor it, Call said.

On Dec. 5, Mazurek said he supports Call’s project. “The system we have now seems broken,” he said. “We have such high premiums for health insurance because it’s private.” He also said he hoped statewide efforts like Call’s would help average Americans by building support so that H.R. 676 would pass in Congress.

Congresswoman-elect Chellie Pingree of North Haven said throughout the election campaign that she would sign on to H.R. 676. If it comes to the Congress in this session, she said Dec. 8, she will support the bill. But she added that the election of Barack Obama has changed the discussion about health care.

“The new Democratic Congress will mean more movement,” she said. “It’s a different dynamic when you have a president with a vision.” Pingree said she didn’t think she’d have a lot of clout as a freshman in the House, but she will push for single-payer or the most comprehensive reform possible. “We don’t want Congress to end up passing another iteration of managed care,” she said.

According to an article in the Sept. 24, 2007, issue of the Palm Beach Post, businesses contributed $2,600 per employee, or $217 monthly, to employee health insurance in 2005. Under H.R. 676, employers’ average cost would be $1,425 annually, or $119 a month. According to a study by economist Dean Baker of the Center for Economic Research and Policy, a family of three making $40,000 annually would spend approximately $1,900 yearly for coverage. The Post article quotes the National Coalition on Health Care as saying that the average private insurance premium cost this same family $11,000.

The Web site for Republicans for Single-Payer states that close to a third of every health-care dollar is spent on administrative costs, and calls single-payer “the conservative approach to providing access to health care with informed choice of private providers.”

Call’s recent presentation pointed to a 2001 analysis by Health Affairs that showed 35 percent of drug companies’ costs going to advertising and marketing. He said 47 percent of the cost of workers’ compensation goes for medical payments that would be covered by the new program, thus saving employers even more.

The USNHI program would be funded through a payroll tax on employers and employees of 3.3 percent each, added to the 1.45 percent payroll tax each pays now, totaling 4.75 percent each. The top 5 percent of income earners, those earning $250,000 a year or more, would pay a 5 percent health tax and those at the top 1 percent would pay 10 percent. A small tax on stock and bond transactions amounting to one-third of 1 percent would also contribute to the USNHI program. Closing corporate tax loopholes and repealing the Bush tax cut for the highest income-earners would bring the estimated savings up to $56 billion.

With President-elect Obama’s emphasis on reforming the health-care system, Call said it’s important for citizens to express their preference for H.R. 676 as early and emphatically as possible.

“The thing that drives me is that a number of years ago I was diagnosed with cancer,” said Call. “I remember sitting in the doctor’s office and thinking, ‘If I can live with this I’m going to find a way to repay to society for my good fortune.’ This is the way.”

For information on H.R. 676, visit hr676.org. Call can be reached at midcoasthealthcarereform.org or by calling 596-7784.

This article appeared on VillageSoup.com.

Healthcare petition urges: Everybody In, Nobody Out

For more than five years, medical students from the University of Kansas Medical Center have put in long hours serving uninsured patients at their Jay Doc Free Clinic.

Last year, a number of students and physicians involved in such efforts started a new group, Heartland Healthcare for All. Their aim is to push universal health care beyond the walls of their free clinics and into federal legislation that would leave no patient behind.

With a new president preparing to take office, they’re not wasting any time sending their ideas to Washington, D.C.

Elizabeth Stephens, a medical student at KU Med and a member of Heartland Healthcare for All, says the organization started with a viewing of Michael Moore’s 2007 documentary, Sicko, which criticizes the current model of private health care as ineffective and unjust.

“They left the movie outraged by what they had seen,” Stephens says of a group of students and professionals at the screening. “They started talking in the lobby and decided to form a group of concerned citizens.”

Since then, the HHFA has organized vigils and protests to advance a more equitable system. They’ve thrown their weight behind a publicly financed, single-payer system, like the one proposed by Michigan Congressman John Conyers and co-sponsored by Missouri U.S. Rep. Emanuel Cleaver. “We really believe the most equitable and most cost-effective way to truly have a system where everybody’s in and nobody’s left out is a single-payer system,” Stephens says.

Now the group is trying to get more citizens on board.

After Barack Obama became the Democratic nominee for president, his campaign called for citizens to hold meetings in their homes and to discuss the changes they’d like to see in Washington, D.C. About 40 people showed up to an HHFA-sponsored gathering to talk about health care, Stephens says. The group came up with a unanimous vision. They put that wording down on paper. Now they’ve turned that session into an online petition that demands: “Everybody In, Nobody Out.”

In the two weeks since it went live, the effort has gained more than 100 signatures. Stephens says the hope is to get as many names as possible and then send the message to the new president once he takes office.

“He’s asked for input from the people who elected him,” Stephens says of Obama. “We thought this would be a great time to show the president-elect and local representatives and senators there is strong support for this and people want it. Politicians aren’t ever going to go out on their own and do something radical. They have to know the people who voted for them want that change first. We want to demonstrate wide support for this so they can get behind it, as well.”

This weekend, the Obama camp is once again calling on citizens to throw house parties to jump-start political discussions. Before then, though, the members of HHFA will gather at the same free clinic that hosts the Jay Docs tonight to keep pushing for a system that’s open to everyone.

This article is from pitch.com.

When a Job Disappears, So Does the Health Care

ASHLAND, Ohio � As jobless numbers reach levels not seen in 25 years, another crisis is unfolding for millions of people who lost their health insurance along with their jobs, joining the ranks of the uninsured.

The crisis is on display here. Starla D. Darling, 27, was pregnant when she learned that her insurance coverage was about to end. She rushed to the hospital, took a medication to induce labor and then had an emergency Caesarean section, in the hope that her Blue Cross and Blue Shield plan would pay for the delivery.

Wendy R. Carter, 41, who recently lost her job and her health benefits, is struggling to pay $12,942 in bills for a partial hysterectomy at a local hospital. Her daughter, Betsy A. Carter, 19, has pain in her lower right jaw, where a wisdom tooth is growing in. But she has not seen a dentist because she has no health insurance.

Ms. Darling and Wendy Carter are among 275 people who worked at an Archway cookie factory here in north central Ohio. The company provided excellent health benefits. But the plant shut down abruptly this fall, leaving workers without coverage, like millions of people battered by the worst economic crisis since the Depression.

About 10.3 million Americans were unemployed in November, according to the Bureau of Labor Statistics. The number of unemployed has increased by 2.8 million, or 36 percent, since January of this year, and by 4.3 million, or 71 percent, since January 2001.

Most people are covered through the workplace, so when they lose their jobs, they lose their health benefits. On average, for each jobless worker who has lost insurance, at least one child or spouse covered under the same policy has also lost protection, public health experts said.

Expanding access to health insurance, with federal subsidies, was a priority for President-elect Barack Obama and the new Democratic Congress. The increase in the ranks of the uninsured, including middle-class families with strong ties to the work force, adds urgency to their efforts.

�This shows why � no matter how bad the condition of the economy � we can�t delay pursuing comprehensive health care,� said Senator Sherrod Brown, Democrat of Ohio. �There are too many victims who are innocent of anything but working at the wrong place at the wrong time.�

Some parts of the federal safety net are more responsive to economic distress. The number of people on food stamps set a record in September, with 31.6 million people receiving benefits, up by two million in one month.

Nearly 4.4 million people are receiving unemployment insurance benefits, an increase of 60 percent in the past year. But more than half of unemployed workers are not receiving help because they do not qualify or have exhausted their benefits.

About 1.7 million families receive cash under the main federal-state welfare program, little changed from a year earlier. Welfare serves about 4 of 10 eligible families and fewer than one in four poor children.

In a letter dated Oct. 3, Archway told workers that their jobs would be eliminated, and their insurance terminated on Oct. 6, because of �unforeseeable business circumstances.� The company, owned by a private equity firm based in Greenwich, Conn., filed a petition for relief under Chapter 11 of the Bankruptcy Code.

Archway workers typically made $13 to $20 an hour. To save money in a tough economy, they are canceling appointments with doctors and dentists, putting off surgery, and going without prescription medicines for themselves and their children.

Archway cited �the challenging economic environment� as a reason for closing.

�We have been operating at a loss due largely to the significant increases in raw material costs, such as flour, butter, sugar and dairy, and the record high fuel costs across the country,� the company said.

At this time of year, the Archway plant would usually be bustling as employees worked overtime to make Christmas cookies. This year the plant is silent. The aromas of cinnamon and licorice are missing. More than 40 trailers sit in the parking lot with nothing to haul.

In the weeks before it filed for bankruptcy protection, Archway apparently fell behind in paying for its employee health plan. In its bankruptcy filing, Archway said it owed more than $700,000 to Blue Cross and Blue Shield of Illinois, one of its largest creditors.

Richard D. Jackson, 53, was an oven operator at the bakery for 30 years. Mr. Jackson and his two daughters often used the Archway health plan to pay for doctor�s visits, imaging, surgery and medicines. Now that he has no insurance, he takes his Effexor antidepressant pills every other day, rather than daily, as prescribed.

Another former Archway employee, Jeffrey D. Austen, 50, said he had canceled shoulder surgery scheduled for Oct. 13 at the Cleveland Clinic because he had no way to pay for it.

�I had already lined up an orthopedic surgeon and an anesthesiologist,� Mr. Austen said.

In mid-October, Janet M. Esbenshade, 37, who had been a packer at the Archway plant, began to notice that her vision was blurred. �My eyes were burning, itching and watery,� Ms. Esbenshade said. �Pus was oozing out. If I had had insurance, I would have gone to an eye doctor right away.�

She waited two weeks. The infection became worse. She went to the hospital on Oct. 26. Doctors found that she had keratitis, a painful condition that she may have picked up from an old pair of contact lenses. They prescribed antibiotics, which have cleared up the infection.

Ms. Esbenshade has two daughters, ages 6 and 10, with asthma. She has explained to them why �we are not Christmas shopping this year � unless, by some miracle, Mommy goes back to work and gets a paycheck.�

She said she had told the girls, �I would rather you stay out of the hospital and take your medication than buy you a little toy right now because I think your health is more important.�

In some cases, people who are laid off can maintain their group health benefits under a federal law, the Consolidated Omnibus Budget Reconciliation Act of 1986, known as Cobra. But that is not an option for former Archway employees because their group health plan no longer exists. And they generally cannot afford to buy insurance on their own.

Wendy Carter�s case is typical. She receives $956 a month in unemployment benefits. Her monthly expenses include her share of the rent ($300), car payments ($300), auto insurance ($75), utilities ($220) and food ($260). That leaves nothing for health insurance.

Ms. Darling, who was pregnant when her insurance ran out, worked at Archway for eight years, and her father, Franklin J. Phillips, worked there for 24 years.

�When I heard that I was losing my insurance,� she said, �I was scared. I remember that the bill for my son�s delivery in 2005 was about $9,000, and I knew I would never be able to pay that by myself.�

So Ms. Darling asked her midwife to induce labor two days before her health insurance expired.

�I was determined that we were getting this baby out, and it was going to be paid for,� said Ms. Darling, who was interviewed at her home here as she cradled the infant in her arms.

As it turned out, the insurance company denied her claim, leaving Ms. Darling with more than $17,000 in medical bills.

The latest official estimate of the number of uninsured, from the Census Bureau, is for 2007, when the economy was in better condition. In that year, the bureau says, 45.7 million people, accounting for 15.3 percent of the population, were uninsured.

M. Harvey Brenner, a professor of public health at the University of North Texas and Johns Hopkins University, said that three decades of research had shown a correlation between the condition of the economy and human health, including life expectancy.

�In recessions, with declines in national income and increases in unemployment,� Mr. Brenner said, �you often see increases in mortality from heart disease, cancer, psychiatric illnesses and other conditions.�

The recession is also taking a toll on hospitals.

�We have seen a significant increase in patients seeking assistance paying their bills,� said Erin M. Al-Mehairi, a spokeswoman for Samaritan Hospital in Ashland. �We�ve had a 40 percent increase in charity care write-offs this year over the 2007 level of $2.7 million.�

In addition, people are using the hospital less. �We�ve seen a huge decrease in M.R.I.�s, CAT scans, stress tests, cardiac catheterization tests, knee and hip replacements and other elective surgery,� Ms. Al-Mehairi said.

This article is from the New York Times.

PBS Ombud Sides with Frontline Critics

By FAIR–

PBS ombud Michael Getler is siding with critics of a Frontline documentary that failed to examine single-payer national health insurance as a possible alternative to the U.S. healthcare system.

Citing FAIR’s study “Media Blackout on Single-Payer Healthcare,” which documented that single-payer advocates were all but shut out of the media discussion about healthcare reform, Getler stated:

I find myself in agreement with those who wrote initially and who felt it was a missed opportunity by Frontline to shed some light on where this specific idea – clearly telegraphed in the previous program about how other countries do it, enjoying some level of popular and professional support and formalized in a bill before Congress – stood in today’s political environment.

The only alternative to the current U.S. healthcare system that was examined in any depth in Sick Around America was Massachusetts’ system of mandating that people buy insurance from for-profit health insurance companies. FAIR had criticized the film for misrepresenting the findings of Frontline’s earlier documentary, Sick Around the World (4/15/08), which had emphasized that all other countries ban insurance companies from making a profit on basic care, and had discussed single payer alternatives including Taiwan’s healthcare system.

Today, FAIR’s radio program CounterSpin airs an interview with T. R. Reid–a Frontline reporter for Sick Around the World who quit the production of Sick Around America because it contradicted the earlier Frontline documentary. (Audio file available here).

Obama sets up formal office for healthcare reform

WASHINGTON (Reuters) – President Barack Obama set up an executive office for healthcare reform at the White House on Wednesday, saying the overhaul was one of the biggest priorities for the first year of his presidency.

Obama issued an executive order that says the U.S. healthcare system “suffers from serious and pervasive problems.”

The White House Office of Health Reform (Health Reform Office) will help the executive branch steer “the federal government’s comprehensive effort to improve access to health care, the quality of such care, and the sustainability of the health care system,” the order reads.

It also says the Secretary of Health and Human Services will create an Office of Health Reform to work with the White House office.

Obama has nominated former Clinton administration health official Nancy-Ann DeParle to lead the White House office. His nominee for Health and Human Services secretary is Kansas Governor Kathleen Sebelius.

The new office will help ensure that policymakers across the executive branch work toward Obama’s healthcare agenda, the order reads.

U.S. government economists predict that public and private health spending will hit $2.5 trillion this year, taking up a 17.6 percent share of gross domestic product.

Yet studies suggest Americans get poorer care than people in other industrialized countries that have national healthcare plans, and 46 million Americans have no health insurance at all.

Congressman Ryan Hides After Trying to Attack Medicare in San Francisco

From Don Bechler of Single Payer Now –

Congressman Paul Ryan (R-WI) came to SF on May 24 to raise funds for his attacks on Medicare, Medicaid, Social Security, and Gay Marriage. He is the point person for the 1% attacks on our social investments. He was scheduled to speak at the GAP headquarters, but the GAP told him to move his fundraiser after massive outrage by the gay and healthcare communities.

He then cancelled his fundraiser at the GAP.

Activists from the California Alliance for Retired Americans, Gray Panthers, and Single Payer Now held a press conference at the GAP headquarters to denounce his attacks. We got coverage in both the San Francisco Chronicle and on KPFA radio.

Department of Defense signs on with Continua Health Alliance

BEAVERTON, OR – The Department of Defense (DoD) has joined the Continua Health Alliance, which promotes connectivity of personal health devices and advocates for standards-based interoperability guidelines.

On Tuesday, Continua announced that DoD's Joint Program Committee-1, through the U.S. Army Medical Research and Materiel Command, Telemedicine and Advanced Technology Research Center (TATRC), has joined the alliance, an international not-for-profit industry organization, which seeks to advance personal connected health by promoting end-to-end, plug-and-play connectivity.

“Continua is honored to welcome the U.S. Department of Defense to our membership," said Clint McClellan, senior director of strategic marketing at Qualcomm Life, who serves as Continua's board president and chairman. "As a longstanding leader in the development and implementation of connected health strategies, we look forward to working with the Joint Program Committee-1 and TATRC to advance the use of technology to support health and wellness for our Armed Forces and the general public.

“Continua values our partnerships with industry, healthcare provider organizations and government agencies around the globe," he added. "Together, we are working to create an ecosystem of interoperable health technologies to support the convenient and secure collection and sharing of personal health data.”

Joint Program Committee-1 (JPC-1) and TATRC have played a significant role in developing advanced technologies in areas such as health informatics, medical imaging, mobile computing and remote monitoring.

“JPC-1 and TATRC look forward to participating in Continua and assuming an active role in the organization’s working groups to help advance interoperability and the adoption of personal connected health solutions,” added Robert E. Connors, of the Henry M. Jackson Foundation for the Advancement of Military Medicine, and executive health manager at TATRC under the Interpersonnel Government Act.
 

10 of the largest data breaches in 2012 ... so far

We're six months into 2012, and numerous headlines have showcased some large health data breaches. Whether it's outright theft, the actions of a disgruntled employee or overall carelessness, 2012 is already chock-full of noteworthy breaches. And according to recent research, the problem is only growing. 

Here are 10 of the largest data breaches in 2012... so far. 

1.Utah Department of Health. On March 30, approximately 780,000 Medicaid patients and recipients of the Children's Health Insurance Plan in Utah had personal information stolen after a hacker from Eastern Europe accessed the Utah Department of Technology Service's server. Initially, the number of those affected stood at 24,000, yet, according to UDOH, that number grew to 780,000, with Social Security numbers stolen from approximately 280,000 individuals and less-sensitive personal data stolen from approximately 500,000 others. The reason the hacker was able to access this information? Ultimately, it was due to a weak password.

2.Emory Healthcare. On April 18, Emory Healthcare in Atlanta announced a data breach after the organization misplaced 10 backup disks, which contained information for more than 315,000 patients. The 10 disks held information on surgical patients treated between 1990 and 2007 at Emory University Hospital Midtown and the Emory Clinic Ambulatory Surgery Center. Of the 315,000 patient files, approximately 228,000 included Social Security numbers, with other sensitive information at risk including names, dates of surgery, diagnoses, and procedure codes.

3.South Carolina Department of Health. An employee of the South Carolina Department of Health and Human Services was arrested on April 19 after he compiled data on more than 228,000 people and sent it to a private email account. Approximately 22,600 people had their Medicaid ID numbers taken, which were linked to their Social Security numbers. Others had names, addresses, phone numbers, and birth dates stolen as a result of the act. The former employee, Christopher Lykes Jr., was charged with five counts of violating medical confidentiality laws and one count of disclosure of confidential information. 

[See also: 12 steps for surviving a privacy breach investigation.]

4.Howard University Hospital. Toward the end of March, Howard University Hospital in Washington D.C. notified approximately 34,503 patients of a potential disclosure of their PHI that supposedly occurred in late January. A laptop, which was password protected, was stolen from a contractor's vehicle, yet, according to the hospital, no evidence suggested any patient files were accessed. The records stolen did contain Social Security numbers for many of the patients affected. Today, the hospital requires all laptops issued to Howard University Health Sciences employees to be encrypted.

5.St. Joseph Health System. In February, St. Joseph Health System, in California, alerted approximately 31,800 patients of a possible security breach at three of their organizations throughout the state. According to the system, security settings were "incorrect," which allowed for the potential breach. Information accessed didn't include Social Security numbers, addresses, or financial data, yet patients' names and medical data were vulnerable. The records at risk were mostly for inpatients who received care from February through August of 2011. The data, the organization said, would have been available through Internet search engines from early 2011 to February 2012. 

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Genetic testing: Does Kristen Powers have mom's fatal gene?

CHAPEL HILL, N.C.�Just a little while ago, Kristen Powers was being a rowdy teenager, singing loudly and swaying to an upbeat Katy Perry song in the back seat of her family's car on the way to a long-awaited appointment.

But now, her face and eyes are still, void of any expression. She is sitting in a hospital examination room, bracing herself to come to terms with the most important news of her young life. After turning 18, she decided to get tested for Huntington's disease, an incurable neurodegenerative illness that claimed her mother's life last year at age 45. It is considered a death sentence by many because it can begin debilitating people in their mid-30s, the prime of life.

"We have good news for you today," says Debbie Keelean-Fuller, genetic counselor at children's outpatient clinic at University of North Carolina.

"You tested negative."

The results, Keelean-Fuller adds, mean neither Kristen nor her children will get Huntington's. In a nanosecond, a smile bursts onto Kristen's face, her eyes light up and her father folds her in his arms.

Genetic testing and disease: Would you want to know?

This behind-the-scenes look at a young woman�s decision to test for Huntington�s disease, an incurable hereditary disease, is the second in a series.

Part 1: Kristen's story

"These are the same tears (of joy) I cried the day you were born," Ed Powers says to his firstborn child.

Kristen's stepmother, Betsy Banks Saul, and best friend, Daniel Woldorff, quickly join in the group hug.

"Oh. My. God." Kristen says softly with both hands pressing the sides of her face.

Children have a 50-50 chance of inheriting the rare disease from their parents. Kristen Powers told USA TODAY in April she had decided to get genetic testing for two reasons: for herself � "I always craved getting information" � and for the larger Huntington's disease community.

She said before she got her test results that she would want to be honest about her diagnosis with future partners, and would not have children for fear of passing on the gene. She also said she wants to raise awareness about an illness many families try to hide.

One way she's doing that is by making a documentary. She has raised more than $18,000 on crowd-funding website Indiegogo to hire a video crew to document her experiences with genetic testing.

"She is going to empower an entire generation at risk of developing Huntington's disease," says Mary Edmondson, a psychiatrist at Duke University's specialty Huntington's disease clinic. "The more you can do to empower people, the more they can master the skills required to deal with the disease."

Kristen grew up surrounded by fear and uncertainty. Her parents divorced, and her mother had custody for several years. But when Nicola Powers' disease progressed and she could no longer care for Kristen and her younger brother, Nate, their father gained custody. Kristen was 9. She recalls her mother stumbling, and walking "like a drunk person at times. That's before we knew what was wrong with her. It was really scary."

By the time she was 11, Kristen says, she understood that she was also at risk. She feels she's waited a lifetime to learn the truth about her genetic heritage. Nate has also decided to test for Huntington's when he turns 18.

Not everyone wants to know

Genetic testing isn't for everyone, though, and is not conclusive at diagnosing every disease.

"Some people don't test for Huntington's because other family members don't want to know," says Kristen, adding that one reason a young person might not test is because a positive result would mean a parent would also have the disease. The parent just might not be displaying symptoms yet.

Many people say they wouldn't want to know whether they have the disease, according to James Evans, a medical geneticist and director at the University of North Carolina's Bryson Program for Human Genetics.

"After I give talks, I ask audiences if they'd want to be tested" for various conditions, he says. "And about half of the audience will raise their hands."

Keelean-Fuller says one reason some people don't want to test is insurance-related. Though the federal health care law prevents insurance companies from discriminating against people because of pre-existing conditions, the entire law � or parts of it � could be ruled unconstitutional when the Supreme Court issues a ruling later this month.

"Also, it can be hard for people to get disability insurance, long-term care insurance and life insurance with some conditions," she says. "Those are very important concerns to families."

Accepting responsibility

Knowing whether you have the Huntington's gene, Kristen says, means accepting responsibility for your life. She was prepared to become the face of the disease. She still plans to push for a cure.

"People with positive tests and negative tests go through a year of adjustment," says Edmondson. "There is an opportunity for tremendous personal growth."

Kristen graduates from high school on Saturdayand will begin college at Stanford University in California in September.

Before leaving the hospital, her step-mom asks Kristen if she thinks she'll finetune her identity now, since so much of hers has been branded by being at genetic risk.

"I don't know," she says, taking a few seconds to think. "I guess so."

Then she beams again. When asked whether she has started making plans for the future, she draws a blank again. Her head is still back in the exam room.

"All I can hear is, 'We have good news,' and the rest is a blur," she says.

Then Kristen gets in her dad's car, and the Huntington's-free teen heads to school to tell her friends the good news and rejoice.

Houston HIE to connect 130 hospitals via 'network of networks'

HOUSTON – Greater Houston Healthconnect announced Thursday that it will partner with Medicity to establish a community-wide health information exchange, connecting more than 130 hospitals and some 14,000 physicians in a 20-county region of Southeast Texas.

Officicials say Healthconnect will bridge existing networks of major health systems, together with independent hospitals and providers to improve care quality and lower costs for 7 million area residents.

Healthconnect has received signed letters of interest in support of the HIE from the major providers in the Texas Medical Center, officials say. With every major health system in Houston having or planning to implement an HIE for their organization, Healthconnect will work with them to link their HIEs to each other, creating an interoperable, standards-based network of networks that adds value to the IT investments these health systems have already made.

"We're excited to begin working with Medicity to establish a safe, efficient, low-cost way to share medical information among providers," said Lamar Pritchard, Healthconnect board member and dean of the College of Pharmacy at the University of Houston. "We selected Medicity's technology due to their experience and track record of interfacing with all major EHR systems currently in use by area hospitals. Medicity has helped more than 800 hospitals achieve connectivity without disrupting existing systems. One of the biggest benefits of the technology is its ability to easily integrate with any major EHR system, which will facilitate rapid implementation in Houston and allow for sustainable growth in the future."

UPMC deploys Wi-Fi-based RFID

PITTSBURGH – University of Pittsburgh Medical Center has implemented RFID technology to automate temperature monitoring at UPMC St. Margaret Hospital, and it will soon roll out wireless monitoring and asset tracking across most of its U.S. hospitals.

Officials say UPMC will deploy AeroScout’s Healthcare Visibility Solutions, which use advanced radio frequency identification (RFID) technology that will leverage UPMC’s standard Wi-Fi network to avoid the purchase, installation and maintenance of a proprietary RFID network.

After researching real-time location systems (RTLS) for several years, UPMC decided to use a Wi-Fi-based solution to leverage the investment in its Wi-Fi network and the related expertise it had developed, officials say. AeroScout technology can use low frequency and ultrasound for additional use cases such as par level management, and offers integration capabilities to allow other UPMC software providers to utilize location and condition information, for instance, temperature readings, for specific clinical and operational applications.

"After our extensive testing and due diligence, it was clear to us that Wi-Fi-based healthcare visibility solutions were not only the best model for our health system, but also the standard that would prevail industry-wide because of the important advantages they offer over proprietary systems," said James Venturella, CIO, Physician and Hospital Services at UPMC. "By using our existing Wi-Fi infrastructure, the AeroScout solutions are easier to deploy, allowing us to see the associated productivity and patient care benefits more quickly."

The asset management technology enables UPMC staff to track the location of critical medical equipment throughout its facilities, ensuring that it's at the right place at the right time and eliminating the need to manually search for items.

UPMC uses the temperature monitoring solution to automatically and wirelessly monitor the temperature of refrigerators and freezers, helping prevent spoilage of medicines, vaccines and even food. Both applications free up a significant amount of time so that staff can focus on caring for patients, officials say.

Following the success of its current implementation, UPMC plans to extend the technology. It will use AeroScout when it introduces a SmartRoom system at its new UPMC East hospital in Monroeville, which is scheduled to open this summer. Officials say the SmartRoom will use RTLS to identify caregivers as they walk into a patient’s room and provide clinicians with real-time, relevant information at the patient’s bedside.

Youth diabetes, pre-diabetes rates soar

Diabetes and pre-diabetes have skyrocketed among the nation's young people, jumping from 9% of the adolescent population in 2000 to 23% in 2008, a study reports today.

The findings, reported in the journal Pediatrics, are "very concerning," says lead author Ashleigh May, an epidemiologist with the Centers for Disease Control and Prevention.

"To get ahead of this problem, we have to be incredibly aggressive and look at children and adolescents and say you have to make time for physical activity," says pediatric endocrinologist Larry Deeb, former president of medicine and science for the American Diabetes Association.

Of the two types of diabetes, type 2 accounts for more than 90% of cases. In people with diabetes, the body does not make enough of the hormone insulin or doesn't use it properly.

Insulin helps glucose (sugar) get into cells, where it is used for energy. If there's an insulin problem, sugar builds up in the blood, damaging nerves and blood vessels. Long-term complications of diabetes can include heart attacks, blindness, kidney failure, nerve damage and amputations.

May and colleagues examined health data on about 3,400 adolescents ages 12 to 19 from 1999 through 2008. They participated in the CDC's National Health and Nutrition Examination Survey, considered the gold standard for evaluating health in the USA because it includes a detailed physical examination, taking participants' blood pressure and getting fasting blood sugar levels. Their weight and height also are measured.

May notes that the diabetes findings should be interpreted with caution because the fasting blood glucose test was used and there are disadvantages associated with the test. Instead, many physicians use the A1C test, which looks at a person's average blood sugar levels for the past three months.

"I wouldn't be surprised if pre-diabetes and diabetes went up some, but how much it may have gone up is still an open question because of the way they measured it," says Stephen Daniels, chairman of the department of pediatrics at the University of Colorado School of Medicine and a spokesman for the American Heart Association.

Still, about a third of adolescents are overweight or obese, which increases their risk of high blood pressure, type 2 diabetes and other health problems.

Deeb says other research suggests there will be "a 64% increase in diabetes in the next decade," which is even higher than the predicted increase in obesity, "because stress on the pancreas and insulin resistance catches up with people. We are truly in deep trouble. Diabetes threatens to destroy the health care system."

The Pediatrics report also found that overall, half of overweight teens and almost two-thirds of obese adolescents have one or more risk factors for heart disease, such as diabetes, high blood pressure or high levels of bad cholesterol. By comparison, about one-third of normal-weight adolescents have at least one risk factor.

When these risk factors are present in young people, the problems may persist into adulthood, May says.

Says Daniels, "The fact that we have kids who already have risk factors is disconcerting because their risk of cardiovascular disease is already starting to increase."

These Health Law Bets Are No Figure Of Speech

Images_of_Money/Flickr

How much would you wager on the constitutionality of the sweeping federal health law?

The stakes are high in the U.S. Supreme Court's consideration of the 2010 health law, as countless commentators have observed. In some circles, however, the gambling metaphor has been pushed to its logical conclusion.

Bernstein Research stock analyst Ana Gupte laid 50 percent odds recently on chances that the court will strike down the Affordable Care Act's individual mandate along with strict coverage requirements. Over at Intrade, a "prediction market" for current events, the betting Tuesday morning gave chances of about 58 percent that the court will disallow the mandate, which requires people to obtain health coverage or pay a fine.

On the FantasySCOTUS Web site, 54 percent of an audience composed largely of law students and clerks predicted the mandate will be thrown out.

Declaring Vegas-style odds on court rulings isn't the norm for Wall Street analysts such as Gupte. But the Supreme Court decision, expected to be announced at the end of June, is critical for the health-insurance stocks she covers. She puts low probabilities � 15 percent in each case � on chances that the court will uphold the entire law or strike the whole thing down.

 

Predictions about the act's ability to survive whole grew more pessimistic after March's oral arguments from lawyers on each side. Many analysts believed questions from key justices such as Anthony Kennedy and Chief Justice John Roberts betrayed an inclination against the mandate.

At Intrade, bettors raised the odds of the mandate being ruled unconstitutional from less than 40 percent before the arguments to more than 60 percent afterwards. In recent days, however, they've backed off. Intrade deals pay off at $10, and at this morning's prices you could buy a contract on a negative Supreme Court decision for the mandate for $5.76. Buying a chance to win $10 for $5.76 amounts to laying 58 percent odds on your bet.

At FantasySCOTUS no money changes hands. Winners get "bragging rights," said Corey Carpenter, director of analysis for the Harlan Institute, an educational nonprofit affiliated with the site. Predictions on FantasySCOTUS of the mandate's demise saw little increase following the arguments, perhaps because the site's audience pays more attention to legal logic than media coverage, Carpenter said.

The biggest bets on the Supreme Court decision come in the stock market. Insurance companies gained billions of dollars in market value after the oral arguments on expectations of a favorable outcome for the industry. But their prices have drifted back down.

Insurers worry that the court could block the mandate but uphold a separate requirement that they accept all members at a uniform price regardless of pre-existing illnesses. Such an outcome would deprive the companies of billions in new revenue while at the same time assigning them expensive liabilities.

After analyzing the oral arguments, however, Gupte said there's a 50 percent chance that the court will toss the coverage requirements and the mandate at the same time. That's the "most likely" outcome and would raise insurer profits by 7 percent on average, she wrote. Partly as a result, she's bullish on several insurer stocks, including UnitedHealth Group, Cigna and Aetna.

Not all oddsmakers believed the oral arguments occasioned a new betting line. Andrew Cohen, a CBS News legal analyst and contributing editor for The Atlantic, promised to update his odds, set last fall on The Atlantic's site, on how individual justices would vote.

"Having picked [the] wrong horse in last five Kentucky Derbys," he said viaTwitter, "I decided not to chance it."