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News Article | April 19, 2017
Site: www.npr.org

Many Veterans Gained Health Care Through The Affordable Care Act Almost half a million veterans gained health care coverage during the first two years of the Affordable Care Act, a report finds. In the years leading up to the implementation of the ACA's major coverage provisions, from 2010 to 2013, nearly 1 million of the nation's approximately 22 million veterans didn't have health insurance. Almost half of all veterans are enrolled in the VA health system; others get health care through employers or Medicare. But some don't quality for those options, and others don't know that they have them. Two years after the ACA's implementation, 429,000 veterans under the age of 65 gained coverage, which is a 40 percent drop in vets without insurance from 2013 to 2015. The vets were covered for the most part through Medicaid expansion, privately purchased plans and marketplace coverage, according to the report. The number of insured veterans rose across demographics like age, gender, race and education level. "The gains in coverage were really broad," says Jennifer Haley, a research associate at the Urban Institute, a research group based in Washington, D.C., who was an author on the report. Veterans with the lowest incomes saw the greatest increase in coverage, especially in states that adopted Medicaid expansion. Vets with incomes up to 138 percent of the federal poverty level, or $16,394 a year for an individual, became eligible for Medicaid in expansion states, the report notes. In 2015, just 4.8 percent of veterans were uninsured in states that participated in Medicaid expansion, compared to 7.1 percent in states that did not. One in 5 uninsured vets live in states that did not expand Medicaid and would have been eligible for coverage had their state chosen to expand the program, the report found. Haley says these are key data points when considering changes to policy. "If states would adopt the expansion, more vets would qualify for publicly supported coverage," she says. Currently, 31 states and the District of Columbia have expanded Medicaid programs, including California, New York, Pennsylvania and Illinois. Another 19 states, including Florida and Texas, have not expanded access to the program. Veterans weren't the only ones to benefit from expanded insurance access. Their family members had access to more coverage, too, and by a similar margin. The overall rate of uninsurance among relatives sank from 9.2 percent in 2013 to 4.5 percent in 2015. For children, the rates fell from 4.5 to 2.9 percent. Overall, 730,000 fewer vets and their family members were lacking health insurance from 2013 to 2015. The report, published by the Urban Institute, used data from the American Community Survey, which is performed annually by the U.S. Census Bureau. It surveys around 100,000 veterans and 100,000 family members of veterans. The report also considered data from the National Health Interview Survey which is conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. A repeal of the ACA or a rollback of Medicaid could negate these coverage increases and leave more vets without health insurance coverage, the authors note in their report. The VA health system continues to struggle with delays in delivery of services to veterans. On Wednesday, President Donald Trump signed a law extending the Veterans Choice program, which allows some vets get health care from private providers paid for by the VA and was created to help improve access to timely care. The $10 billion program has been riddled with problems, as Montana Public Radio's Eric Whitney reports, including long waits, a confusing, complicated system and delayed payments to providers.


News Article | May 2, 2017
Site: www.futurity.org

Getting half of American 8- to 11-year-olds into 25 minutes of physical activity three times a week would save $21.9 billion in medical costs and lost wages over their lifetimes, new research suggests. The relatively modest increase—from the current 32 percent to 50 percent of kids participating in exercise, active play, or sports that often—would also result in 340,000 fewer obese and overweight youth, a reduction of more than 4 percent, the study calculates. “Physical activity not only makes kids feel better and helps them develop healthy habits, it’s also good for the nation’s bottom line,” says Bruce Y. Lee, executive director of the Global Obesity Prevention Center at Johns Hopkins University. “Our findings show that encouraging exercise and investing in physical activity such as school recess and youth sports leagues when kids are young pays big dividends as they grow up.” The study, published in the journal Health Affairs, suggests an even bigger payoff if every current 8- through 11-year-old in the United States exercised 75 minutes over three sessions weekly. In that case, the researchers estimate, $62.3 billion in medical costs and lost wages over the course of their lifetimes could be avoided and 1.2 million fewer youths would be overweight or obese. And the savings would multiply if not just current 8-to-11 year olds, but every future cohort of elementary school children upped their game. Studies have shown that a high body mass index at age 18 is associated with a high BMI throughout adulthood and a higher risk for diabetes, heart disease, and other maladies linked to excess weight. The illnesses lead to high medical costs and productivity losses. In recent decades, there has been what experts describe as a growing epidemic of obesity in the United States. Lee and colleagues from the Johns Hopkins Bloomberg School of Public Health and the Pittsburgh Supercomputing Center at Carnegie Mellon University developed a computer simulation using their Virtual Population for Obesity Prevention software. They plugged in information representing current US children to show how changes in physical activity as kids could affect them—and the economy—throughout their lifetimes. The model relied on data from the 2005 and 2013 National Health and Nutrition Examination Survey and from the National Center for Health Statistics. Exercise totaling at least 25 minutes a day, three days a week, is a guideline developed for kids by the Sports and Fitness Industry Association. The researchers found that maintaining the current low 32 percent compliance would result in 8.1 million of today’s 8- to 11-year-olds being overweight or obese by 2020. That would trigger $2.8 trillion in additional medical costs and lost wages over their lifetimes. An overweight person’s lifetime medical costs average $62,331 and lost wages average $93,075. For an obese person, these amounts are even greater. “Even modest increases in physical activity could yield billions of dollars in savings,” Lee says. The costs averted are likely an underestimate, he says, as there are other benefits of physical activity that don’t affect weight, such as improving bone density, improving mood, and building muscle. Lee says that the spending averted by healthy levels of physical activity would more than make up for costs of programs designed to increase activity levels. “As the prevalence of childhood obesity grows, so will the value of increasing physical activity,” he says. “We need to be adding physical education programs and not cutting them. We need to encourage kids to be active, to reduce screen time and get them running around again. It’s important for their physical health—and the nation’s financial health.” Funding for the research came from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Agency for Healthcare Research and Quality.


News Article | April 28, 2017
Site: www.sciencenews.org

Cancer prevention isn’t the first thing that comes to many parents’ minds when they consider vaccinating their preteens against human papillomavirus, or HPV. And the fact that HPV is transmitted sexually gives the vaccine more baggage than a crowded international flight. But what gets lost in the din is the goal of vaccination, to protect adolescents from infection with HPV types that are responsible for numerous cancers. Newly released estimates show just how prevalent HPV infections are in the United States. In April, the U.S. Centers for Disease Control and Prevention reported for 2013-2014 that among adults ages 18 to 59, 25 percent of men and 20 percent of women had genital infections with HPV types that put them at risk of developing cancer. That’s just a snapshot in time. For those who are sexually active, more than 90 percent of men and 80 percent of women can expect to become infected with at least one type of HPV during their lives. About half of those infections will be with a high-risk HPV type. “People who think, ‘I’m not at risk,’ are really not understanding the magnitude of this virus,” says cancer epidemiologist Electra Paskett of Ohio State University in Columbus. HPV is the most common sexually transmitted infection in the United States. The HPV group of viruses includes low-risk and high-risk types. Low-risk types 6 and 11 are responsible for 90 percent of all genital warts. The high-risk types of HPV can cause cancer, and the two behind most HPV-related cancers are types 16 and 18. Seventy percent of cervical cancers can be traced back to types 16 and 18, while type 16 also causes cancers of the anus, vagina, penis and the oropharynx, the part of the throat at the back of the mouth. HPV spreads by sexual contact, either vaginal, anal or oral. Nationally, from 2011 to 2014, 11 percent of men ages 18 to 69 had an oral infection with any type of HPV, and for nearly 7 percent of men, it was a high-risk type, the CDC’s National Center for Health Statistics estimated in its April report. For women in this age group, it was 3 percent and 1 percent, respectively. The numbers are far worse when it comes to genital HPV infections. During 2013 to 2014, 45 percent of men and 40 percent of women ages 18 to 59 had genital infections with any type of HPV. One in four men and one in five women in this age group were infected with a high-risk type. “It’s a wake-up call for both genders, but particularly for males,” says Jessica Keim-Malpass, a nurse scientist at the University of Virginia in Charlottesville. For an estimated 19,200 women and 11,600 men each year, HPV infections result in a cancer diagnosis. Vaccination could greatly relieve this cancer burden. Three different HPV vaccines have been available in the United States. The first, introduced in 2006, covered low-risk types 6 and 11 and high-risk types 16 and 18. The most recent HPV vaccine protects against these four types as well as five more high-risk types, and is the only vaccine currently distributed nationally. A federal advisory committee recommended routine vaccination against HPV at 11 or 12 years of age in 2006 for girls and in 2011 for boys. But the HPV-cancer prevention message doesn’t seem to be getting through in the United States. HPV vaccination rates lag behind the national coverage goal of 80 percent for 13- to 15-year-olds. In 2015, among U.S. adolescents ages 13 to 17, six out of 10 girls and five out of 10 boys had gotten at least one shot in a three-shot series. But only four out of 10 girls and three out of 10 boys had completed the series. Parents are part of the issue. “They don’t know about the vaccine, or they have fears about safety, or they say ‘My child is not going to be at risk for HPV infections,’” Paskett says. The safety of all three vaccines was established in large clinical trials before approval by the U.S. Food and Drug Administration. Since 2006, almost 90 million doses of HPV vaccines have been administered nationally, and the most common side effects are soreness or swelling at the site of the shot. Some parents think that “by giving the vaccine, you are saying it’s OK to have sex,” notes Keim-Malpass. Research doesn’t back this up. A 2012 study in Pediatrics of 11- to 12-year-old girls found that HPV vaccination was not tied to increased sexual activity, as measured by medical records of sexually-transmitted infection or pregnancy. A 2015 study in JAMA Internal Medicine of 12- to 18-year-old girls found no evidence to link HPV vaccination with higher rates of sexually transmitted infections. The recommended age for vaccination ensures that preteens are protected before they are exposed to HPV, whenever that may be. “The whole reason the vaccine is targeted to 11- and 12-year-olds is to get kids vaccinated before they enter a sexual relationship,” says Keim-Malpass. Lack of urgency is a problem, too. The delay between an infection and a future cancer can make people complacent about HPV. “You are protecting yourself from an infection, but it has ramifications years, decades later,” Keim-Malpass says. “It’s not about something you get tomorrow, it’s about something you could get 20 to 30 years from now.” Another difficulty has been the vaccination schedule. The initial recommendation was for three doses, with the second shot one to two months after the first, and the third shot six months after the first. This schedule was challenging for busy adolescents, notes Keim-Malpass. Now there is a new dosing regimen. For adolescents who begin vaccination before turning 15, only two shots are required, with the second one coming six to 12 months after the first. This should be easier to accommodate in yearly well-child visits. Even with the suboptimal vaccination rates, there has been an impact on infections. A 2016 Pediatrics study found that, within six years of the first vaccine’s introduction in 2006, infections with the four HPV types covered decreased 64 percent among 14- to 19-year-old girls. There are also fewer cases of genital warts among U.S. teens since 2006. Any decline in infection rates is a good thing. But “it’s not to the extent we could have, if from the get- go, people realized this was a cancer vaccine,” says Paskett. “If there was a vaccine for breast cancer, moms would be lining up around the corner with their daughters.”


Martin J.A.,National Center for Health Statistics
MMWR. Surveillance summaries : Morbidity and mortality weekly report. Surveillance summaries / CDC | Year: 2011

Preterm infants (those born at <37 completed weeks of gestation) are less likely to survive to their first birthday than infants delivered at higher gestational ages, and those who do survive, especially those born at the earlier end of the preterm spectrum, are more likely to suffer long-term disabilities than infants born at term. During 1981--2006, the U.S. preterm birth rate increased >30%, from 9.4% to 12.8% of all live births. Although lower during 2007 and 2008, the U.S. preterm birth rate remains higher than any year during 1981--2002.


Ogden C.L.,National Center for Health Statistics
National health statistics reports | Year: 2011

The high prevalence of obesity (defined by body mass index) among children and adolescents in the United States and elsewhere has prompted increased attention to body fat in childhood and adolescence. This report provides smoothed estimates of major percentiles of percentage body fat for boys and girls aged 8-19 years in the United States. Percentage body fat was obtained from whole-body, dual-energy x-ray absorptiometry (DXA) scans conducted during the 1999-2004 National Health and Nutrition Examination Survey. A nonparametric double-kernel method was employed to smooth percentile curves for the DXA data. The pattern of body fat development differs between boys and girls aged 8-19 years. In most age groups, girls have a higher percentage of body fat than boys. Among boys, there is a drop in body fat percentage in early adolescence that is especially pronounced at the higher percentiles. Among girls this pattern is not seen; percentage body fat increases slightly with age. These results provide a smoothed reference distribution of percentage body fat for U.S. children and adolescents aged 8-19 years.


MacDorman M.F.,National Center for Health Statistics
National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System | Year: 2010

OBJECTIVES: This report examines trends and characteristics of out-of-hospital and home births in the United States. METHODS: Descriptive tabulations of data are presented and interpreted. RESULTS: In 2006, there were 38,568 out-of-hospital births in the United States, including 24,970 home births and 10,781 births occurring in a freestanding birthing center. After a gradual decline from 1990 to 2004, the percentage of out-of-hospital births increased by 3% from 0.87% in 2004 to 0.90% in 2005 and 2006. A similar pattern was found for home births. After a gradual decline from 1990 to 2004, the percentage of home births increased by 5% to 0.59% in 2005 and remained steady in 2006. Compared with the U.S. average, home birth rates were higher for non-Hispanic white women, married women, women aged 25 and over, and women with several previous children. Home births were less likely than hospital births to be preterm, low birthweight, or multiple deliveries. The percentage of home births was 74% higher in rural counties of less than 100,000 population than in counties with a population size of 100,000 or more. The percentage of home births also varied widely by state; in Vermont and Montana more than 2% of births in 2005-2006 were home births, compared with less than 0.2% in Louisiana and Nebraska. About 61% of home births were delivered by midwives. Among midwife-delivered home births, one-fourth (27%) were delivered by certified nurse midwives, and nearly three-fourths (73%) were delivered by other midwives. DISCUSSION: Women may choose home birth for a variety of reasons, including a desire for a low-intervention birth in a familiar environment surrounded by family and friends and cultural or religious concerns. Lack of transportation in rural areas and cost factors may also play a role.


Dwyer L.L.,National Center for Health Statistics
Journal of the American Geriatrics Society | Year: 2013

To estimate infection prevalence and explore associated risk factors in nursing home (NH) residents, individuals receiving home health care (HHC), and individuals receiving hospice care. Cross-sectional. Nationally representative samples of 1,174 U.S. NHs in the 2004 National Nursing Home Survey (NNHS) and 1,036 U.S. HHC and hospice agencies in the 2007 National Home and Hospice Care Survey (NHHCS). A nationally representative sample of 12,270 NH residents, 4,394 individuals receiving HHC, and 4,410 individuals receiving hospice care. International Classification of Diseases, Ninth Revision, Clinical Modification, codes were used to identify the presence of infection, including community-acquired infection and those acquired during earlier healthcare exposures. Unweighted response rates were 78% for the 2004 NHHS and 67% for the 2007 NHHCS. Approximately 12% of NH residents and 12% of individuals receiving HHC had an infection at the time of the survey interview, and more than 10% of individuals receiving hospice care had an infection when discharged from hospice care. The most common infections were urinary tract infection (3.0-5.2%), pneumonia (2.2-4.4%), and cellulitis (1.6-2.0%). Short length of care and recent inpatient stay in a healthcare facility were associated with infections in all three populations. Taking 10 or more medications and urinary catheter exposure were significant in two of these three long-term care populations. Infection prevalence in HHC, hospice, and NH populations is similar. Although these infections may be community acquired or acquired during earlier healthcare exposures, these findings fill an important gap in understanding the national infection burden and may help inform future research on infection epidemiology and prevention strategies in long-term care populations.


As part of the Affordable Care Act, primary care physicians providing services to patients insured through Medicaid in some states will receive higher payments in 2013 and 2014 than in the past. Payments for some services will increase to match Medicare rates. This change may lead to wider acceptance of new Medicaid patients among primary care providers. Using data from the 2011-12 National Ambulatory Medical Care Survey Electronic Medical Records Supplement, I summarize baseline rates of acceptance of new Medicaid patients among office-based physicians by specialty and practice type. I also report state-level acceptance rates for both primary care and other physicians. About 33 percent of primary care physicians (those in general and family medicine, internal medicine, or pediatrics) did not accept new Medicaid patients in 2011-12, ranging from a low of 8.9 percent in Minnesota to a high of 54.0 percent in New Jersey. Primary care physicians in New Jersey, California, Alabama, and Missouri were less likely than the national average to accept new Medicaid patients in 2011-12. The data presented here provide a baseline for comparison of new Medicaid acceptance rates in 2013-14. ©2013 Project HOPE-The People-to-People Health Foundation, Inc.


Lubitz J.D.,National Center for Health Statistics
Health Services Research | Year: 2010

Objective. To update research on Medicare payments in the last year of life. Data Sources. Continuous Medicare History Sample, containing annual summaries of claims data on a 5 percent sample from 1978 to 2006. Study Design. Analyses were based on elderly beneficiaries in fee for service. For each year, Medicare payments were assigned either to decedents (persons in their last year) or to survivors (all others). Results. The share of Medicare payments going to persons in their last year of life declined slightly from 28.3 percent in 1978 to 25.1 percent in 2006. After adjustment for age, sex, and death rates, there was no significant trend. Conclusions. Despite changes in the delivery of medical care over the last generation, the share of Medicare expenditures going to beneficiaries in their last year has not changed substantially. © Health Research and Educational Trust.


Decker S.L.,National Center for Health Statistics
Health Affairs | Year: 2012

When fully implemented, the Affordable Care Act will expand the number of people with health insurance. This raises questions about the capacity of the health care workforce to meet increased demand. I used data on office-based physicians from the 2011 National Ambulatory Medical Care Survey Electronic Medical Records Supplement to summarize the percentage of physicians currently accepting any new patients. Although 96 percent of physicians accepted new patients in 2011, rates varied by payment source: 31 percent of physicians were unwilling to accept any new Medicaid patients; 17 percent would not accept new Medicare patients; and 18 percent of physicians would not accept new privately insured patients. Physicians in smaller practices and those in metropolitan areas were less likely than others to accept new Medicaid patients. Higher state Medicaid-to-Medicare fee ratios were correlated with greater acceptance of new Medicaid patients. The findings serve as a useful baseline from which to measure the anticipated impact of Affordable Care Act provisions that could boost Medicaid payment rates to primary care physicians in some states while increasing the number of people with health care coverage. © 2012 Project HOPE- The People-to-People Health Foundation, Inc.

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