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Repeal Of Health Law Could Force Tough Decisions For Arizona Republicans

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Connie Dotts is a big fan of her insurance.

“I like that we can choose our own doctors,” said the 60-year-old resident of Mesa, Ariz. “They also have extensive mental health coverage.”

Dotts isn’t on some pricey plan, either. She’s among the nearly 2 million people enrolled in Medicaid in Arizona and one of the more than 400,000 who have signed up since the Republican-led state expanded Medicaid in 2014.

Her eight prescription drugs are cheap, Dotts said, and she has no copays or premiums. The Medicaid benefits have helped her manage her emphysema, depression and osteoarthritis.

But taking care of other problems has to be delayed: “I have torn ligaments in my ankles, and I can’t take the time off work to go to physical therapy or surgery.”

Dotts works in retail and lives paycheck to paycheck. Without Medicaid, she said, she wouldn’t be able to afford to see a doctor. “It’s just barely above what they consider livable income. Any extensive medical issues would put an excessive burden on me,” she said.

The replacement health plan the GOP leaders are pushing in Congress would gradually cut off the federal funding for Medicaid that expanded eligibility. The bill also bars any additional states from expanding Medicaid immediately.

Swapna Reddy, a professor at Arizona State University’s School for the Science of Health Care Delivery, said that as Congress overhauls the health care law, a state like Arizona might particularly suffer.

Unlike some states that expanded Medicaid, Arizona saw a rush of people joining the rolls, Reddy says, because it had a “high-need, uninsured” population.

The Republican bill would continue to pay the higher federal rates that the ACA’s Medicaid expansion offered people like Dotts, Reddy said — but only if they’re already enrolled in Medicaid, and their personal income stays about the same.

“What we know about the Medicaid population is that they kind of fall in and out of eligibility on a regular basis,” she said, because the amount of money they earn tends to fluctuate.

“So it has the real potential of eradicating Medicaid expansion over a period of time,” Reddy says.

The states and the federal government share the cost of Medicaid. Instead of an open-ended entitlement, the bill making its way through Congress right now would cap the federal government’s contribution or turn it into a block grant.

Putting a fixed limit on the federal government’s contribution is unlikely to allow Arizona Medicaid to keep up with the growing cost of covering people, Reddy said.

“The states will have to come up with the remaining money to cover these folks,” she said.

The Republican health plan would eventually cost Arizona nearly half a billion dollars a year, according to calculations by the state, to keep the adults with the lowest income in the expansion population insured. It’s a group that Arizona voters actually required the state to cover in 2000 through a ballot initiative. But during the recession in later years, financial pressure led state lawmakers to freeze enrollment for those adults.

Scaling back Medicaid could be a particularly risky proposition for Arizona, according to the state program’s administrators, because Arizona is already one of the most efficient, lean programs in the country.

Getting locked in at the current funding rates would give other states a leg up, said Tom Betlach, who runs Medicaid in Arizona.

“If they are able to achieve improved outcomes and reduced costs, they are able to capture those savings,” Betlach said. “Versus we actually get penalized for being a good steward of taxpayer funds.”

Betlach said Arizona needs more control than it currently has over who and what types of treatments and procedures are covered if the federal government intends to give Arizona only a fixed amount of cash.

The federal fight over health care puts the state’s Republican governor, Doug Ducey, in a tricky situation. Ducey has said he would like the ACA repealed, but he has also said he doesn’t want hundreds of thousands of people to lose coverage. He has expressed concern that the GOP bill doesn’t give the state enough flexibility.

And it wasn’t even on Ducey’s watch that Arizona expanded Medicaid. The expansion happened under Jan Brewer, Arizona’s former governor and an ally of President Donald Trump. To pull that off, Brewer had to band together with Democrats and buck some of her fellow Republicans in the state Legislature, who then sued her over the expansion. In their lawsuit, the legislators claimed that the way the state pays its share — a fee on hospitals — is unconstitutional.

At a recent court hearing for that long-running lawsuit, Brewer defended her controversial decision to accept the ACA’s expansion funding.

“I think it was the right thing to do,” she said in an interview outside the courtroom. “It saved lives. It insured more people. It brought money into the state. It kept rural hospitals from being closed down. And today there are tens of thousands of people that are very, very grateful.”

But some Republicans, like state Sen. Debbie Lesko, who was among the Arizona legislators who sued Brewer, figured the day would come when the feds would try to roll back the funding.

“I voted against Medicaid expansion, not because I don’t want people to get health coverage,” Lesko said, “but because I’m a realist and I know how much we can afford in our budget.”

This story is part of a partnership that includes KJZZ, NPR and Kaiser Health News.

How a 'Bad Food' Attitude Can Backfire

Do you struggle with cravings and wish you had the will power to cut out certain foods completely? When we work toward a healthy diet, so many of us think that making a list of food culprits and calling them off-limits will help us to succeed. However, if you take a deeper look at the psychology behind this flawed method, you’ll see so many reasons why adopting a ''good food'' or ''bad food'' attitude will never work.  Restricting certain foods won't just make dieting miserable--it can also ruin your good intentions of getting healthy and losing weight. Making arbitrary rules about good and bad food isn’t the answer to lasting lifestyle change. Instead, use the tips below to build a better relationship with food, learn to master cravings, build self-control and enjoy all foods in moderation.   Stop Labeling Foods as 'Good' and 'Bad' For decades, behavior analysts have studied the effects of deprivation on people’s preferences for food, tangible items and activities. The majority of literature on this topic says that, when we’re deprived of something, we’re more likely to select that particular item from an array of choices. In a recent study conducted at the University of Toronto at Mississauga, researchers found that participants who were asked to restrict either high-carb or high-protein foods for three days reported higher cravings for the banned foods. So, if you label chocolate as evil and forbid it from your menu, you’ll be more likely to want it in any form.   The good news is that some level of satiation (satisfying your craving for a particular food) can actually help you to avoid overindulging more often than not. If you can be conscious about your eating and have just enough of your favorite chocolate bar to satisfy that craving, you’ll be much less tempted to dip into the candy jar on your co-worker’s desk or buy a sweet snack from the vending machine.   This information about deprivation seems like common sense, but you’ve probably heard from friends or fellow dieters that the first step in avoiding high-calorie foods is putting them out of your mind altogether. Not true! Researchers are realizing that suppressing thoughts about a particular food can cause an increase in consumption of that food. In a 2010 study, 116 women were split into three groups. The first group was asked to suppress thoughts about chocolate, the second group was asked to actively think about chocolate, and the third group was instructed to think about anything they wished. Afterward, each of the participants was given a chocolate bar. The women who had suppressed their thoughts about chocolate ate significantly more chocolate than the others, despite identifying themselves as more ''restrained eaters'' in general. This just goes to show that ''out of mind'' doesn’t necessarily always mean ''out of mouth.''   Dump the Idea of 'Diet Foods' Often, when people are trying to eat better, they start to categorize foods into those that are on their diet plan and those that are not. However, banning specific foods from your weight-loss plan may just make you crave them more.  According to an article published this year in the journal Appetite, a UK study of 129 women measured the cravings of those who were ''dieting'' to lose weight, ''watching'' to maintain their weight, and not dieting at all. The researchers found that, compared with non-dieters, dieters experienced stronger, more irresistible cravings for the foods they were restricting.   Noticing the difference between healthy and unhealthy options is definitely key in establishing a pattern of better eating. And, when you’re starting a weight-loss program, it does help to read food labels and menus carefully so that you can choose wisely. However, when you start to categorize specific foods such as candy, baked goods, alcohol and fried chicken as foods you can’t have, you’re setting yourself up for a backfire. The issue with labeling a food as a forbidden substance is that your thoughts immediately center on that particular item... and then you inadvertently start bargaining and rationalizing to get more of it. (How many times have you broken your ''diet rules'' to reward a trip to the gym with chocolate or a long day at work with a cocktail or two?)   There are some diet plans out there that advocate choosing a particular day of the week as your ''cheat day''--a day when you can indulge in all the foods you’ve cut out during the week. But listing certain foods as ''cheats'' or ''treats'' can set up a scenario where you’re depriving yourself all week long and constantly looking to the future, waiting on the moment that you’ll be showered with your favorite forbidden goodies (like those commercials where fruit-flavored candies fall from a rainbow).   Besides causing you to crave, labeling certain foods as ''forbidden'' makes it really difficult to be mindful of and content with the healthy food you’re eating most of the time. Instead of worrying about restricting foods, try to redirect your focus on creating the most delicious salad, grilling a succulent chicken breast or munching a juicy piece of fruit. If you turn your attention to the abundance of healthy options in front of you instead of weighing the pros and cons of particular foods, you’ll be more likely to really relish and rejoice in your everyday choices.   Make Sense of 'Moderation' You’ve heard the line a thousand times: Everything in moderation. But what does this phrase really mean and how can you apply it to your healthy eating plan? Usually, people hand this advice out when they’re indulging in unhealthy food and drink and trying to get you to join in, say at a wedding or birthday party. So is it just peer pressure? Or is there something to this age-old saying?   Choosing to eat all foods in moderation works just fine for some people. If you have a healthy relationship with food (e.g., you have no trouble putting away the bag of chips after just one serving), then eating a little bit of your favorite food may satisfy your craving and leave you full until the next healthy meal.   However, for some people, it just doesn’t work that way. Sweets, salts and alcohol all cause biological reactions in the body that are hard to ignore. And, if you’re someone who responds strongly to these reactions, even one small bite can trigger you to continue sampling similar goodies. If you’re one of these folks, you’re definitely not alone, and it is important to know which foods affect you in these ways. Perhaps you’re a person who can have a bite of a sundae and pass the rest on to your spouse, but a fun-size candy bar can unravel your motivation and spark unhealthy choices for the rest of the day. Noting which tempting foods are your triggers can help you arrange your environment so that you don’t overindulge.   Rearranging your environment for success is the easiest way to change your behavior. If you do decide to indulge in a ''trigger food'' in moderation, opt to eat it in a place where there aren't any other snack options for you to munch on afterwards (a food-filled party would not be the best environment!). Choose snacks that you like, but don't love, so you're not tempted to eat too much but are still satisfied. Understanding which foods are likely to lead you down a slippery slope and preparing your environment and schedule for success will help you keep cravings at bay and keep your overeating under control.   Keep Cravings in Check Cravings are a good thing. On a basic, biological level, cravings tell us when we’re hungry, thirsty, sleepy and even when we need some human attention. The problem is that, because we’re so accustomed to having easy access to eat whenever we want and we’re able to choose from many unhealthy foods, the ratio of our wants and needs are all out of whack! It is time to step back and become aware of what we’re really craving and why. When we can look objectively at our yearnings for soda, chips, cake and cookies, we can make much better decisions about what we put in our mouths.   One of the best ways to get back in touch with your true cravings is to keep track of them.  For a few days, keep a journal of the time of day, what you’re craving, and whether you’re at work, at home, on the road, with your kids, etc. You can still give in to temptation—this exercise will simply give you a clearer picture of how often you crave, what you crave and in what settings those cravings occur.   In behavior science, before we try to change any habit, we do an assessment like this to look at the person’s current patterns so that we can set goals for small, stepwise changes. You’ll likely notice a pattern quickly (e.g., I always want something sweet with my 10 a.m. coffee). Then you can put some measures in place to deter this craving or make a healthy choice before it happens (e.g., I’ll start bringing a piece of fruit to eat with coffee so I don’t grab a muffin from the break room).   With a little mindfulness, you can ditch the ''good food, bad food'' attitude! Plan carefully and stay in tune with your body to make sensible decisions that will satisfy your cravings and promote weight loss.        References:   James A.K. Erskine & George J. Georgiou. 4 February 2010. Effects of thought suppression on eating behaviour in restrained and non-restrained eaters. Appetite 54, 3 (2010):499-503.   Jennifer S. Coelho, Janet Polivy, C. Peter Herman. 16 May 2006. Selective carbohydrate or protein restriction: Effects on subsequent food intake and cravings. Appetite 47, 3 (November 2006): 352-360.   David B. McAdam, Kevin P. Klatt, Mikhail Koffarnus, Anthony Dicesare, Katherine Solberg, Cassie Welch, & Sean Murphy. The effects of establishing operations on preferences for tangible items. Journal of Applied Behavior Analysis 38 (2005): 107-110.   Anna Massey & Andrew J. Hill. 18 January 2012. Dieting and food craving. A descriptive, quasi-prospective study. Appetite 58, 3 (June 2012): 781–785. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1770

How to Grow Your Own Herbs for Cooking

The next time a recipe calls for fresh basil, skip the poor substitute of dried basil, forgo the last-minute dash to the supermarket for some overpriced wilted basil, and just pluck a few tender leaves off of the basil plant you have growing in your very own herb garden.  What? You don't have fresh basil growing in your garden? Well consider this your invitation to start. Growing your own herbs is a simple and inexpensive undertaking that pays off big for your taste buds and your budget.  If you can keep a houseplant alive, you can sustain an herb garden.  Here’s how. Decide what you want to grow.  Some popular choices from home cooks are listed here along with their care instructions.  Start with just a few that you know you’ll use regularly, and then branch out from there. Herb Special Care How to Harvest How to Use Basil Pinch off any flowers that appear. This preserves the plant’s flavor, and will also help increase the leaf density of each stem. Harvest the upper leaves first, taking just a few leaves from each stem at a time. Add raw to salads, sandwiches and wraps, cook into soups and sauces, chop and sprinkle on pizza, make pesto. Parsley Parsley has a longer than average germination period of three to four weeks, so extra patience is required. Cut the outermost stalks just above ground level, which will encourage further growth. Both the leaves and stalks can be eaten in salads, soups, and Mediterranean dishes like Tabouli. Chives If you don’t intend on eating the flowers, pinch them off as soon as they begin to appear. Cut the leaves with scissors, starting with the outside leaves first, allowing about 2 inches of the leaves to remain. This entire plant can be eaten from top to bottom— the bulbs taste like mild onions, the leaves can be used in salads and other dishes, and even the flower heads can be tossed into salads. Cilantro Cilantro does not like hot weather. If the soil temperature reaches 75 degrees, the plant will bolt and go to seed, making this a short-lived herb. Aggressive pruning will extend its life, so be ready to use or store it. Save the seeds to use in cooking (the seeds are called coriander) or to plant. There are two methods of harvesting cilantro. When the plant reaches about 6" in height, you can remove the outer leaves with a scissors, leaving the growing point intact for new growth. Or you can wait until the plant is almost completely grown and pull it from the soil by its roots to use the whole bunch at once. Salads, wraps, dips, and many Mexican recipes. Rosemary This plant can be difficult to start from seed, so you may wish to buy a mature plant. And be careful not to overwater—rosemary likes its soil on the dry side. Simply cut off pieces of the stem as you need it. Many culinary and even medicinal uses. Thyme This plant can take awhile to start from seed, so you may wish to buy a mature plant. Drought-tolerant thyme is extremely easy to care for, and prefers drier soils. Simply cut off pieces of the stem as you need it. Often used to flavor meats, soups, and stews. Dill Drought-tolerant dill is extremely easy to care for, and prefers drier soils. Don't start harvesting dill until it's at least 12 inches tall, and never take more than one-third of the leaves at any one time. Great flavoring for fish, lamb, potatoes, and peas. Mint Mint is an invasive plant so stick to container gardening with this one. Pinch off sprigs as you need them. Mint is extremely versatile, and can be used in salads, desserts, drinks, and many other recipes. You can even chew it by itself for a pleasant, refreshing flavor.   Decide where to plant your herbs. Many herbs grow well indoors and outdoors in the ground or in containers.  If you have a little space with at least 5 hours of direct sunlight a day, you may prefer to grow them indoors, as the herbs will be much more accessible for cooking and watering, and not subject to threats of pests, weeds, or variations in temperature. Decide whether you’ll start from seeds or seedlings.  Seedlings are very young plants that you can transplant into your own garden. They are typically only available in the spring and summer from gardening centers and farmers markets.  Seeds cost less, but take more time and resources to grow from scratch (here's how). Gather your materials.  You’ll need a few gardening tools, like a small shovel or spade, some gardening gloves and pots or containers (optional since herbs can also be planted directly into the soil). You’ll also need some fertilized soil.  If you have a compost pile, you can use some fully decomposed compost to fertilize the soil.  Otherwise, you can use a general purpose compost solution, available in any gardening store.   If you’re container gardening, use a packaged potting soil mix, which will be free of pests. Start planting.  If you’re starting from seeds, sow into moist soil and cover with 1/2 inch of soil on top.  The seeds should germinate in about one week.  If you’re using a pot or container for seedlings, follow these steps.

  1. Ensure proper drainage by filling the pot with a shallow layer of course gravel.  
  2. Fill the pot about 1/2 of the way full, and place the plant, still in its original container, into the new pot.  Add dirt around the plant, gently packing it into place, so that the top of the new soil is at the same level as the top of the plant’s original soil.   
  3. Remove the plastic pot, tap it so you can easily slide the plant and all of its soil out, and place the plant and all of its soil into the hole in the soil of the new pot.
Care for your plants. Water at the base of the plant when the soil begins to feel dry, at least once per week.  Pull weeds that appear near the plant, because they will steal the nutrients from the soil.  If growing outdoors, bring them in before the first frost. Harvest the herbs.  Most plants will grow new leaves if you don’t pick the stems bare. You can pick the leaves with your fingers or snip them with kitchen shears. Use or store the herbs.  Many recipes call for fresh herbs, so simply pick your herbs, wash them and pat them dry before using in your favorite recipes. To store, you can preserve your herbs for future use by freezing them or drying them.  In either case, you must first prep them.  First, remove any soil or bugs by rinsing in cold water.  Then, remove flowering stems and flowers and gently remove excess water by patting with a paper towel.  Once your herbs are prepped, you can choose your method of storage:
  • Air drying:  Cut the stems at soil level and hang upside down in bunches (so that the flavorful oil travels into the leaves) to dry for one to two weeks.  Once dry, remove the leaves from the stems and store in a dry, airtight container for up to a year.  
  • Freezing:  The benefit of freezing, as opposed to drying, is that the herbs retain more of their just-picked flavor.  Place clean herbs directly into freezer bags, or try the cube method: Place a few teaspoons of chopped, fresh herbs into each cell of an ice cube tray.  Fill the trays with water, and freeze.  When cooking, just pop out a cube and add it to the pot like you would fresh herbs!
Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1739

Break Out of Your Food Rut!

What's for dinner? What are you eating for breakfast or lunch tomorrow? If you aren't feeling excited about your meals, or if your kids are complaining about eating chicken again, you may be in a food rut.   It happens easily; between work obligations, social plans, and kids' soccer practices, we tend to fall back on easy-to-prepare staple meals that don’t require much thought or effort. And for some of us, cooking doesn’t come easily or isn’t a pleasure, so we rely on a handful of recipes we can confidently prepare.   While it's wonderful to have a few go-to meals you can rely on in a pinch, it can get old when you rely on the same meals too often. And that lack of excitement about what's on your plate could lead you to reach for additional snacks or sweets to bring more pleasure back to your eating—which can be a problem if you're trying to manage your weight or eat healthier.   We recently asked SparkPeople members if they were stuck in a diet rut, and we were surprised by how many people replied. Member CHOUBROU summed it up this way: ''The food rut is my biggest problem! I fall into it because eating the same go-to meals is convenient and easy. But eventually I get tired of eating the same thing, and that leads me to the temptation of eating out more, eating more frozen/processed meals, etc.''   SparkPeople member KALENSMOMMY5 asked for help: ''One of the main reasons I fall off the healthy eating wagon is that I get caught in a major food rut! As I am a full-time working single mom to a toddler, I have very limited time to cook, so I end up buying the same grab-and-go foods week after week. The unhealthy choices start to look more and more attractive as I get more bored with my standard foods. Help would be much appreciated!''   Lots of folks told us they’ve hit the wall, cooking-wise. What’s more, they shared great advice on how you can break boring food habits, no matter what causes them.   5 Signs You're Stuck in a Food Rut (and What to Do about It)   Sign #1: You Don’t Enjoy Cooking For many folks, getting dinner on the table is a chore, not a pleasure. If you don’t love to cook, or you’re not confident in your culinary skills, then it's normal to feel like you're in a food rut for awhile—at least until you develop a few basic meals that you can prepare quickly and easily. Here’s how:

  • First, think about what you enjoy eating. Sandwiches? Burritos? Breakfast for dinner? Salads? Consider how you can make those into healthy dinner options.  
  • Settle on three to five things you like, and find simple recipes for those meals. SparkRecipes is a great resource for quick and healthy meal ideas.  
  • Get comfortable with the basics. Once you’ve mastered an essential technique like sautéing boneless chicken breasts, then you can move on to experiment with different sauces or add-ins to change things up over time and prevent yourself from getting bored.  
  • Accept that you don’t love to cook, but don’t let that be your excuse for not eating healthy. If you master a few basic recipes, you’ll gain confidence—and you’ll be making a commitment to yourself.
Sign #2: You’re On Auto-Pilot Even accomplished home cooks tend to get stuck in a rut preparing the same go-to dinners over and over. Katie, a mother of two, posted: ''[My son] calls me on my food ruts—I know I've got problems when my garbage disposal of a kid complains about what I'm cooking.''   Like many folks who commented on our question about food habits, Katie says she refers to cooking magazines (her favorite is Food and Wine) for inspiration when she’s stuck in a routine. Cooking Light magazine and the books ''Cook This, Not That'' by David Zinczenko and Matt Goulding, and ''Fast Food My Way'' by Chef Jacques Pepin were also recommended as great resources for quick and healthy meals.   David posted about different ways to find culinary inspiration: ''I realize [I’m in a food rut] when I’m on auto-pilot preparing a meal that usually gives me joy to cook. I break it up by shopping somewhere new for groceries, or getting a new cooking gadget, or sharpening my knives or getting a new spice.''   A simple strategy for busting out of the auto-pilot cooking rut is to find alternate ways to prepare those go-to meals—in particular, look to different ethnic cuisines for interesting takes on your standards. If spaghetti with meat sauce is in your repertoire, try linguine with spicy shrimp sauce instead. Not feeling that leftover chicken? Turn it into something new, like a tostada. Sometimes simply swapping a few ingredients within a go-to recipe can give you a whole new flavor and make your meals interesting again. Same with sides: If you're always steaming broccoli or brown rice, experiment with other healthy veggies or whole grains such as whole-wheat couscous, millet or quinoa instead.   Sign #3: You Always Eat the Same Meals This food rut often shows up at the start of the day, when we’re so busy getting out the door that we neglect a healthy breakfast, or we choose convenience foods over healthy ones. SparkPeople member LINDSAYHENNIGAN commented that she found herself eating high-fiber breakfast cereal every day: ''I got too focused on how much fiber they added, and failed to notice the 40 grams of sugar I was consuming each morning. My trainer caught it, and switched me over to bread with 2 or less grams of sugar with peanut butter, and I feel so much better.''   SparkPeople member FLUTTEROFSTARS, a vegetarian, shared a bunch of great ideas she enjoys to start her day: ''I’m fighting to get out of my food rut! I’ve been 'Sparking' for two months now, and have come up with several winning mini-meals.'' Some of her favorites include:
  • Salad with Morningstar veggie crumbles and low-fat cheddar cheese
  • Omelets with frozen vegetable blend
  • Greek yogurt with strawberries and flaxseed
  • The ''one-minute microwave muffin'' recipes for breakfast sandwiches from SparkRecipes
We all go through busy periods in our lives—a hectic few weeks at work, an extra-busy sports season—and getting a healthy dinner on the table every evening is even more challenging. Creating a weekly meal plan and then shopping for all the ingredients you’ll need helps avoid the food rut. When you know in the morning what you’re making for dinner that night, you can avoid grabbing quick and not-so-healthy items on that emergency trip to the grocery.  And planning dinners that can be repurposed into lunches avoids brown-bag boredom.   Sign #4: You’re Bored with Brown Bagging We’ll congratulate you for committing to bringing a healthy lunch instead of heading to the nearest fast food joint. But the contents of your brown bag need an overhaul if you’re stuck in the PB&J or turkey sandwich routine day in and day out.   Turning dinner into lunch is a great way to vary your midday meal, especially if you plan ahead and prepare extra food in the evening for the next day’s (or week’s) lunchbox. A dinner of grilled steak and veggies can become a lunchtime salad, and a pasta supper easily transforms into a chilled pasta salad a day later.   SparkPeople member FELIFISH26 posted: ''I usually eat the same boring thing for lunch (half a turkey sandwich on sandwich thin bread, cottage cheese, low-fat chips). BLAH, right?! After awhile your taste buds start to get used to it all, and I could probably be eating cardboard and not know the difference!'' She solved her lunch dilemma by combining some cooked chicken from dinner the night before with fresh pico de gallo that she made with chopped tomato, onion and cilantro. New lunch idea: chicken tacos.   Sign #5: You’re Stuck on ''Diet-Safe'' Foods Several SparkPeople members commented that their commitment to weight loss means they have a limited number of meal options that meet their calorie limits. Member STACYD16 wrote, ''I do believe that I'm in a food rut. I eat the same things daily because I know their caloric contents. I do have a cheat day about once a week that I really enjoy—and I thought that would throw me off, but it has really helped. I realized my issue is more portion control vs. the actual foods that I eat.''   While eating within a calorie range can be a challenge, portion control can help. You can also search for specific recipes within a certain calorie range by using the Advanced Search on SparkRecipes.com. So if you want slow-cooker dinners that contain fewer than 400 calories, simply edit your search options and voila! You'll be surprised just how many delicious and easy meals you can find within your calorie range for any meal.   When All Else Fails: Embrace the Rut Here’s one final strategy for breaking out of your food rut—know that you’ll get into one. Steve posted about exactly that: ''Another thing I'll do is the mid-week ‘king's food’ omelet—where, no matter what, I'll cook an omelet using the leftovers of previous meals. This does two things: It creates interesting flavors with combos I’d normally never think of, and it motivates me to cook good stuff early in the week because it's potential omelet fodder.''   Just as you can't expect perfection when it comes to eating within your calorie range, losing two pounds per week, or exercising as much as you'd like, you can't expect to be perfect in the kitchen, either—or to love every bite you eat. Accept that we all go through ruts with our food. But instead of allowing it to throw you off track, use it as a sign to change things up and find creative ways to make your food fun and delicious again. And remember, this (food rut) too, shall pass!   Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1759

8 Tips for Deciphering Diet Claims

Though food is supposed to be one of life's simple pleasures, few things cause more angst and confusion. It's no wonder why. We're constantly being told which foods we should eat to be healthy, which diets we should follow to be skinny, which preparation methods we should use to be safe, and which chemicals and contaminants in food we should shun to avoid illness. It's enough to give anyone indigestion. If you're confused about what to believe, you've come to the right place. In "Coffee Is Good for You," I'll give you the bottom line on an array of popular diet and nutrition claims in a quick, easily digestible way. Research about diet and health rarely yields the equivalent of DNA evidence, which provides incontrovertible proof. All types of studies come with caveats. However, if interpreted properly, a body of research can allow us to make sound judgments about how believable a claim is. Trying to make sense of the seemingly endless stream of food and nutrition claims can be overwhelming. Remembering the following 8 rules will make the task easier and allow you to stay focused on what’s really important:

  1. Don’t fixate on particular foods. Be wary of lists of miraculous “superfoods” you must eat or “toxic” foods you should never touch. Rather than worrying about squeezing one food or another into your diet, focus on your overall eating patterns, which should include plenty of vegetables, fruits, whole grains, fish, legumes, and good fats, and limited amounts of refined carbohydrates, junk food, red meat, and trans fats.  
  2. Look beyond narrow categories like carbs and calories. Many diet books and seals of approval on foods emphasize one or two factors, such as the calorie or carbohydrate count, while giving short shrift to other important things, like fiber, sodium, or trans fat. The fact that a hamburger is lower in calories than a salad doesn’t necessarily make it a better option. Likewise, just because fruit punch or cereal has added vitamins doesn’t mean it’s healthful. What’s important is the overall nutritional profile. You can get this from comprehensive food- scoring systems such as NuVal, which ranks the healthfulness of foods based on more than 30 factors.  
  3. Forget about fad diets. A plethora of weight- loss plans promise to melt away pounds quickly and easily. But in the long run, they rarely work. About 95 percent of dieters eventually regain lost weight. Instead of searching for the secret to skinniness, which doesn’t exist, try to eat more healthfully and be mindful of how much you’re consuming. Combined with exercise, this approach can prevent weight gain and, over time, lead to weight loss. And unlike dieting, it’s something you can stick with long term.  
  4. Recognize the limits of vitamin pills. While vitamin and mineral supplements can help make up for deficiencies of nutrients, they generally don’t live up to their billing when it comes to preventing disease, boosting energy, or improving your overall health. Supplements pack far less nutritional punch than food, which contains multiple nutrients that interact with one another and with other foods in a variety of complex ways. As a result, vitamin pills can’t compensate for an unhealthful diet. And they can cause harm if you take too much of certain nutrients.  
  5. Ignore health claims on food packages and in ads. A few such claims, such as those related to sodium and high blood pressure, are officially approved by the FDA, but most aren’t. They fall under a loophole that allows companies to use sneaky language like “helps maintain healthy cholesterol levels” or “helps support a healthy immune system.” Because these phrases don’t explicitly say that the food prevents or treats disease— even though that’s what any normal person would infer—manufacturers don’t have to provide any evidence. What’s more, there are no strict definitions for frequently used terms such as all natural, low sugar, and made with whole grains or real fruit. Because it’s virtually impossible to distinguish between legitimate and misleading claims by manufacturers, the best approach is to disregard them all and get your information from the Nutrition Facts panel on the package.  
  6. Verify emails before forwarding them. The vast majority of emails about food and nutrition are half truths or outright hoaxes. If someone forwards you an email claiming, for example, that canola oil is toxic or that asparagus cures cancer, assume it’s not true, no matter how scientific it sounds. Check it out with a reputable source like Snopes. com or Urbanlegends. about. com. Forwarding unconfirmed claims only adds to the hype, misinformation, and confusion.  
  7. Don’t be influenced by just one study. When you encounter news reports about the latest study, don’t jump to conclusions based on that alone. Remember that it’s just one piece of a puzzle. What matters is the big picture— what scientists call the totality of the evidence. For a credible overview of the science, check out online sources such as the Nutrition Source from Harvard School of Public Health, or newsletters such as Nutrition Action Healthletter, the Tufts Health & Nutrition Letter, and the Berkeley Wellness Letter. Or go to www. pubmed. gov and look up the research yourself.  
  8. Enjoy eating! As I said at the beginning of this book, all the admonitions about which foods we should and shouldn’t consume can make eating a stressful chore. But it doesn’t have to be that way. Using science as your guide, focus on the claims with the greatest credibility and relevance, and tune out the rest. That way, you’ll feel less overwhelmed. While following sound nutrition advice is important for good health, it need not spoil your dinner. Bon appétit!
   Adapted with permission from "Coffee is Good for You" by Robert J. Davis, PhD, by arrangement with Perigee, a member of Penguin Group (USA) Inc., Copyright (c) 2012 by Robert J. Davis, PhD, MPH. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1725

GOP Health Plan Aims To Curb Medicaid, Expand State Options

For all its populist design, the House GOP’s latest proposal to overhaul federal Medicaid funding creates financial risks for states and could leave some enrollees worse off.

Dramatic changes in Medicaid are a big part of the House bill to partially repeal the Affordable Care Act that’s steaming toward a floor vote scheduled for Thursday.

Big revisions were made to the legislation this week to appeal to conservatives pushing to reduce federal Medicaid spending and shift more power to states. Advocates for the program fear those measures, if enacted, could lead to cuts in benefits and fewer enrollees in the state-federal health insurance program for low-income people.

“We could see a complete unwinding of the Medicaid program as we know it today,” said Donna Friedsam, a health policy expert at the University of Wisconsin.

One big change in the GOP’s current bill would immediately shut off federal money to allow any more states to expand Medicaid eligibility under the ACA, commonly known as Obamacare. During the past three years, 31 states plus the District of Columbia have taken advantage of the provision, adding about 11 million people to Medicaid, and Kansas is considering the option. States also would gain more latitude to determine Medicaid eligibility and benefits for their populations. And for the first time, states could require some enrollees to work as a condition for getting coverage.

The GOP’s original plan was to begin shifting Medicaid expansion funding away from states in 2020. In the revised bill, states could keep funds after 2020 but only as long as those adults who gained coverage in the expansion stay in the program. When they drop out or lose eligibility, their funding would vanish.

Because of changes in jobs and incomes, many Medicaid enrollees on average lose eligibility within two years, according to Census data.

Regular Medicaid funding also gets an overhaul in the GOP bill.

Since Medicaid’s creation in 1965, everyone eligible has been guaranteed coverage. The federal government’s commitment to help states deal with costs is open-ended, meaning its costs rise as states spend more. The states’ obligation is to cover certain groups of people and to provide specific benefits. Children and pregnant women who meet a state’s income criteria must be protected, for example.

The GOP bill would end that federal commitment, limiting what the government gives states to fixed amounts per year. States could choose two options.

The first way, called a per-capita allotment, means that federal dollars would be allocated to states based on how many Medicaid enrollees they served in a prior year, with annual adjustments for inflation and enrollment increases.

The second way would be a block grant.

Under the revised GOP bill, the block grant option would be available for Medicaid spending only on children, non-elderly adults without disabilities and pregnant women — groups that account for most enrollees.

All states would cover their disabled and elderly populations under the per-capita system, which would get a higher annual inflation rate adjustment than the block grant system under the GOP bill.

The objective is to ensure that funding keeps pace with rising health care costs and the needs of a growing elderly population.

Children could fare badly in states that choose the block grant option, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.

They would no longer be guaranteed access to a standard Medicaid benefit that Congress created in 1967 to ensure that children got access to preventive health care services, treatment and periodic screenings to catch developing health problems early, Alker said.

“That means the governor and/or the state legislature would decide what benefits a child would get, not the child’s pediatrician,” she said.

Of the two funding arrangements, Medicaid block grants also would be financially riskier for states during economic downturns, when unemployment rises and more people seek to enroll in the program. While per-capita caps rise as enrollment grows, block grants do not — and that could leave a state short of federal aid when demand is strongest.

Most states would likely choose a per-capita cap for that reason, said Bill Hammond, director of health policy at the conservative Empire Center for Public Policy in New York.

But some would take a block grant for the freedom they would gain to change benefits and eligibility standards. As a bonus, they would also get to keep any federal money they saved and use it for non-Medicaid spending, he said.

Jason Fichtner, a Medicaid expert at George Mason University in Fairfax, Va., said a block grant would be attractive only for states if they could get more money than under the per-capita option, at least in the short term.

The GOP proposal would allow states to opt out of block-granted funds after 10 years and return to a full per-capita allotment.

Regardless whether the government uses block grants or per-capita caps, the prospects for dramatic changes are already causing shudders among advocates for low-income people.

“Both are really bad options and neither is good for Kentucky and neither is better than what we have now,” said Emily Beauregard, executive director for Kentucky Voices for Health.

Kentucky has a pending request with the Centers for Medicare & Medicaid Services to drastically change its Medicaid program, including adding a requirement that some enrollees work as a condition for enrollment.

The Obama administration consistently rejected states’ requests for a work requirement on the grounds that they would thwart low-income people from getting health care. Studies have found that many Medicaid enrollees who aren’t disabled or elderly already hold jobs, though often in positions that don’t provide health insurance.

The changes in the GOP bill would give states the option starting in October 2017 to add a work requirement for non-disabled adults. Pregnant women and parents of disabled children or children under 6 would be exempt.

Republican leaders said the requirement is modeled on those applied to federal welfare recipients. Under the Kentucky waiver request, people could meet the job requirement by caring for a family member or volunteering.

The work requirement provision is almost certain to face a court challenge if adopted.

A Fact Check Finds Many Misleading Letters From Lawmakers On Health Care

When Louisiana resident Andrea Mongler wrote to her senator, Bill Cassidy, in support of the Affordable Care Act, she wasn’t surprised to get an email back detailing the law’s faults. Cassidy, a Republican who is also a physician, has been a vocal critic.

“Obamacare” he wrote in January, “does not lower costs or improve quality, but rather it raises taxes and allows a presidentially handpicked ‘Health Landing PagesChoices Commissioner’ to determine what coverage and treatments are available to you.”

There’s one problem with Cassidy’s ominous-sounding assertion: It’s false.

The Affordable Care Act, commonly called Obamacare, includes no “Health Choices Commissioner.” Another bill introduced in Congress in 2009 did include such a position, but the bill died — and besides, the job as outlined in that legislation didn’t have the powers Cassidy ascribed to it.

As the debate to repeal the law heats up in Congress, constituents are flooding their representatives with notes of support or concern, and the lawmakers are responding. We decided to take a closer look at these communications after finding misleading statements in an email Sen. Roy Blunt (R-Mo.) sent to his constituents and asked readers to send us communications they had received.

The resulting review of more than 200 such missives by ProPublica and its partners at Kaiser Health News, Stat and Vox found dozens of errors and mischaracterizations about the ACA and its proposed replacement. The legislators have cited wrong statistics, conflated health care terms and made statements that don’t stand up to verification.

It’s not clear if this is intentional, or if the lawmakers and their staffs don’t understand the current law or the proposals to alter it. Either way, the issue of what is wrong — and right — about the current system has become critical as the House prepares to vote on the GOP’s replacement bill Thursday.

“If you get something like that in writing from your U.S. senator, you should be able to just believe that,” said Mongler, 34, a freelance writer and editor who is pursuing a master’s degree in public health. “I hate that people are being fed falsehoods, and a lot of people are buying it and not questioning it. It’s far beyond politics as usual.”

Cassidy’s staff did not respond to questions about Mongler’s letter.

Political debates about complex policy issues are prone to hyperbole and health care is no exception. And to be sure, many of the assertions in the lawmakers’ letters are at least partially based in fact.

Democrats, for instance, have been emphasizing to their constituents that millions of previously uninsured people now have medical coverage thanks to the law. They say insurance companies can no longer discriminate against patients with pre-existing conditions. And they credit the law with allowing adults under age 26 to stay on their parents’ health plans. All true.

For their part, Republicans criticize the law for not living up to its promises. They say former President Barack Obama pledged that people could keep their health plans and doctors, and premiums would go down. Neither has happened. They also say that insurers are dropping out of the market and that monthly premiums and deductibles (the amount people must pay before their coverage kicks in) have gone up. All true.

But elected officials in both parties have distorted evidence and left out important context. Some statements were simply disingenuous. Others were whoppers. And while more Republicans fudged than Democrats, both had their moments.

“Do most people pay that much attention to what their congressman says? Probably not,” said Sherry Glied, dean of New York University’s Robert F. Wagner Graduate School of Public Service, who served as an assistant Health and Human Services secretary from 2010 to 2012. “But I think misinformation or inaccurate information is a bad thing, and not knowing what you’re voting on is a really bad thing.”

We reviewed the emails and letters sent by 51 senators and 134 members of the House within the past few months. Here are some of the most-glaring errors and omissions:

Rep. Pat Tiberi, R-Ohio, incorrectly cited the number of Ohio counties that had only one insurer on the Affordable Care Act insurance exchange.

What he wrote: “In Ohio, almost one third of counties will have only one insurer participating in the exchange.”

What’s misleading: In fact, only 23 percent (less than one quarter) had only one option, according to an analysis by the Kaiser Family Foundation.

His response: A Tiberi spokesperson defended the statement. “The letter says ‘almost’ because only 9 more counties in Ohio need to start offering only 1 plan on the exchanges to be one third.”

Why his response is misleading: Ohio has 88 counties. A 10 percent difference is not “almost.”

Rep. Kevin Yoder, R-Kan., said that the quality of health care in the country has declined because of the ACA, offering no proof.

What he wrote: “Quality of care has decreased as doctors have been burdened with increased regulations on their profession.”

Why it’s misleading: Some data show that health care has improved since the passage of the ACA. Patients are less likely to be readmitted to a hospital within 30 days after they have been discharged, for instance. Also, payments have been increasingly linked to patients’ outcomes rather than just the quantity of services delivered. A 2016 report by the Commonwealth Fund, a health care nonprofit think tank, found that the quality care has improved in many communities following the ACA.

His response: None.

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Rep. Anna Eshoo, D-Calif., misstated the percentage of Medicaid spending that covers the cost of long-term care, such as nursing home stays.

What she wrote: “It’s important to note that 60 percent of Medicaid goes to long-term care and with the evisceration of it in the bill, this critical coverage is severely compromised.”

What’s misleading: Medicaid does not spend 60 percent of its budget on long-term care. The figure is closer to a quarter, according to the Center on Budget and Policy Priorities, a liberal think tank. Medicaid does, however, cover more than 60 percent of all nursing home residents.

Her response: Eshoo’s office said the statistic was based on a subset of enrollees who are dually enrolled in Medicaid and Medicare. For this smaller group, 62 percent of Medicaid expenditures were for long-term support services, according to the Kaiser Family Foundation.

What’s misleading about the response: Eshoo’s letter makes no reference to this population, but instead refers to the 75 million Americans on Medicaid.

Rep. Chuck Fleischmann, R-Tenn., pointed to the number of uninsured Americans as a failure of the ACA, without noting that the law had dramatically reduced the number of uninsured.

What he wrote: “According to the U.S. Census Bureau, approximately thirty-three million Americans are still living without health care coverage and many more have coverage that does not adequately meet their health care needs.”

Why it’s misleading: The actual number of uninsured in 2015 was about 29 million, a drop of 4 million from the prior year, the Census Bureau reported in September. Fleischmann’s number was from the previous year.

Beyond that, reducing the number of uninsured by more than 12 million people from 2013 to 2015 has been seen as a success of Obamacare. And the Republican repeal-and-replace bill is projected to increase the number of uninsured.

His response: None.

Rep. Joseph P. Kennedy III, D-Mass., overstated the number of young adults who were able to stay on their parents’ health plan as a result of the law.

What he wrote: The ACA “allowed 6.1 million young adults to remain covered by their parents’ insurance plans.”

What’s misleading: A 2016 report by the U.S. Department of Health and Human Services, released during the Obama administration, however, pegged the number at 2.3 million.

Kennedy may have gotten to 6.1 million by including 3.8 million young adults who gained health insurance coverage through insurance marketplaces from October 2013 through early 2016.

His response: A spokeswoman for Kennedy said the office had indeed added those two numbers together and would fix future letters.

Rep. Blaine Luetkemeyer, R-Mo., said that 75 percent of health insurance marketplaces run by states have failed. They have not.

What he said: “Nearly 75 percent of state-run exchanges have already collapsed, forcing more than 800,000 Americans to find new coverage.”

What’s misleading: When the ACA first launched, 16 states and the District of Columbia opted to set up their own exchanges for residents to purchase insurance, instead of using the federal marketplace, known as Healthcare.gov.

Of the 16, four state exchanges, in Oregon, Hawaii, New Mexico, and Nevada, failed, and Kentucky plans to close its exchange this year, according to a report by the House Energy and Commerce Committee.  While the report casts doubt on the viability of other state exchanges, it is clear that three-quarters have not failed.

His response: None.

Rep. Dana Rohrabacher, R-Calif., overstated that the ACA “distorted labor markets,” prompting employers to shift workers from full-time jobs to part-time jobs.

What he said: “It has also, through the requirement that employees that work thirty hours or more be considered full time and thus be offered health insurance by their employer, distorted the labor market.”

What’s misleading: A number of studies have found little to back up that assertion. A 2016 study published by the journal Health Affairs examined data on hours worked, reason for working part time, age, education and health insurance status. “We found only limited evidence to support this speculation” that the law led to an increase in part-time employment, the authors wrote. Another study found much the same.

In addition, PolitiFact labeled as false a statement last June by Donald Trump in which he said, “Because of Obamacare, you have so many part-time jobs.”

His response: Rohrabacher spokesman Ken Grubbs said the congressman’s statement was based on an article that said, “Are Republicans right that employers are capping workers’ hours to avoid offering health insurance? The evidence suggests the answer is ‘yes,’ although the number of workers affected is fairly small.”

We pointed out that “fairly small” was hardly akin to distorting the labor market. To which Grubbs replied, “The congressman’s letter is well within the range of respected interpretations. That employers would react to Obamacare’s impact in such way is so obvious, so nearly axiomatic, that it is pointless to get lost in the weeds,” Grubbs said.

Rep. Mike Bishop, R-Mich., appears to have cited a speculative 2013 report by a GOP-led House committee as evidence of current and future premium increases under the ACA.

What he wrote: “Health insurance premiums are slated to increase significantly. Existing customers can expect an average increase of 73 percent, while the average change due to Obamacare for those purchasing a new plan will be a 96 percent increase in premiums. The average cost for a new customer in the individual market is expected to rise $1,812 per year.”

What’s misleading: The figures seem to have come from a report issued before the Obamacare insurance marketplaces launched and before 2014 premiums had been announced. The letter implies these figures are current. In fact, premium increases by and large have been moderate under Obamacare. The average monthly premium for a benchmark plan, upon which federal subsidies are calculated, increased about 2 percent from 2014 to 2015; 7 percent from 2015 to 2016; and 25 percent this year, for states that take part in the federal insurance marketplace.

His response: None

Rep. Dan Newhouse, R-Wash., misstated the reasons why Medicaid costs per person were higher than expected in 2015.

What he wrote: “A Medicaid actuarial report from August 2016 found that the average cost per enrollee was 49 percent higher than estimated just a year prior — in large part due to beneficiaries seeking care at more expensive hospital emergency rooms due to difficulty finding a doctor and long waits for appointments.”

What’s misleading: The report did not blame the higher costs on the difficulty patients had finding doctors. Among the reasons the report did cite: patients who were sicker than anticipated and required a raft of services after being previously uninsured. The report also noted that costs are expected to decrease in the future.

His response: None

Sen. Dick Durbin, D-Ill., wrongly stated that family premiums are declining under Obamacare.

What he wrote: “Families are seeing lower premiums on their insurance, seniors are saving money on prescription drug costs, and hospital readmission rates are dropping.”

What’s misleading:  Durbin’s second and third points are true. The first, however, is misleading. Family insurance premiums have increased in recent years, although with government subsidies, some low- and middle-income families may be paying less for their health coverage than they once did.

His response:  Durbin’s office said it based its statement on an analysis published in the journal Health Affairs that said that individual health insurance premiums dropped between 2013 and 2014, the year that Obamacare insurance marketplaces began. It also pointed to a Washington Post opinion piece that said that premiums under the law are lower than they would have been without the law.

Why his response is misleading:  The Post piece his office cites states clearly, “Yes, insurance premiums are going up, both in the health-care exchanges and in the employer-based insurance market.”

Rep. Susan Brooks, R-Ind., told constituents that premiums nationwide were slated to jump from 2016 to 2017, but failed to mention that premiums for some plans in her home state actually decreased.

What she wrote: “Since the enactment of the ACA, deductibles are up, on average, 63 percent. To make matters worse, monthly premiums for the “bronze plan” rose 21 percent from 2016 to 2017. … Families and individuals covered through their employer are forced to make the difficult choice: pay their premium each month or pay their bills.”

What’s misleading:  Brooks accurately cited national data from the website HealthPocket, but her statement is misleading. Indiana was one of two states in which the premium for a benchmark health plan — the plan used to calculate federal subsidies — actually went down between 2016 and 2017. Moreover, more than 80 percent of marketplace consumers in Indiana receive subsidies that lowered their premium costs. The HealthPocket figures refer to people who do not qualify for those subsidies.

Her response: Brooks’ office referred to a press release from Indiana’s Department of Insurance, which took issue with an Indianapolis Star story about premiums going down. The release, from October, when Vice President Mike Pence was Indiana’s governor, said that the average premiums would go up more than 18 percent over 2016 rates based on enrollment at that time. In addition, the release noted, 68,000 Indiana residents lost their health plans when their insurers withdrew from the market.

Why her response is misleading: For Indiana consumers who shopped around, which many did, there was an opportunity to find a cheaper plan.

Sen. Ron Wyden, D-Ore., incorrectly said that the Republican bill to repeal Obamacare would cut funding for seniors in nursing homes.

What he wrote: “It’s terrible for seniors. Trumpcare forces older Americans to pay 5 times the amount younger Americans will — an age tax — and slashes Medicaid benefits for nursing home care that two out of three Americans in nursing homes rely on.”

What’s misleading: Wyden is correct that the GOP bill, known as the American Health Care Act, would allow insurance companies to charge older adults five times higher premiums than younger ones, compared to three times higher premiums under the existing law. However, it does not directly slash Medicaid benefits for nursing home residents. It proposes cutting Medicaid funding and giving states a greater say in setting their own priorities. States may, as a result, end up cutting services, jeopardizing nursing home care for poor seniors, advocates say, because it is one of the most-expensive parts of the program.

His response: Taylor Harvey, a spokesman for Wyden, defended the statement, noting that the GOP health bill cuts Medicaid funding by $880 billion over 10 years and places a cap on spending. “Cuts to Medicaid would force states to nickel and dime nursing homes, restricting access to care for older Americans and making it a benefit in name only,” he wrote.

Why his response is misleading: The GOP bill does not spell out how states make such cuts.

Rep. Derek Kilmer, D-Wash., misleadingly said premiums would rise under the Obamacare replacement bill now being considered by the House.

What he wrote: “It’s about the 24 million Americans expected to lose their insurance under the Trumpcare plan and for every person who will see their insurance premiums rise — on average 10-15 percent.”

Why it’s misleading: First, the Congressional Budget Office did estimate that the GOP legislation would cover 24 million fewer Americans by 2026. But not all of those people would “lose their insurance.” Some would choose to drop coverage because the bill would no longer make it mandatory to have health insurance, as is the case now.

Second, the budget office did say that in 2018 and 2019, premiums under the GOP bill would be 15 to 20 percent higher than they would have been under Obamacare because the share of unhealthy patients would increase as some of those who are healthy drop out. But it noted that after that, premiums would be lower than under the ACA.

His response: None.

Have you corresponded with a member of Congress or senator about the Affordable Care Act? We’d love to see the response you received. Please fill out our short form.

Charles Ornstein is a senior reporter at ProPublica, a nonprofit news organization based in New York City.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

By Decade’s End, California Estimates It Would Lose $24 Billion Annually Under GOP Health Plan

California would lose $24.3 billion annually in federal funding by 2027 for low-income health coverage under the current Republican plan to replace the Affordable Care Act, according to a state analysis released Wednesday.

The bill, up for a vote in the House on Thursday, represents a “massive and significant fiscal shift” from the federal to state governments by setting caps on Medicaid spending, reducing the amount of money available for new enrollees and eliminating other funding for hospitals and Planned Parenthood, the analysis said.

“It’s really devastating,” said Mari Cantwell, state Medicaid director with the California Department of Health Care Services, who co-wrote the analysis. “It raises some serious questions about whether we can continue to operate the program the way we do today.”

Her boss, department director Jennifer Kent, went further:  “It’s challenging to see how it would not … jeopardize the entire program.”

The analysis, based on internal cost, utilization and enrollment data, was done by the health care services department and the Department of Finance and was shared with California’s congressional delegation.

In 2020 alone, the analysis estimated, the state would lose $6 billion; by 2027, the annual loss would reach $24.3 billion.

Kent said that when faced with shortfalls in the past, the state has made cuts to optional benefits such as adult dental care. The state also could set lower provider rates, or restrict who is eligible. “These are all decisions that California and other states would have to grapple with in the future if this were to be adopted as it is proposed today,” she said.

The impact would vary, of course, depending on the state’s fiscal health.

The Republican bill, called the American Health Care Act, would dramatically change funding for the Medicaid program, known as Medi-Cal in California. Since its inception, Medicaid funding to states has been open-ended, based on need. Under the new bill, federal money would be capped either through block grants or fixed per-capita amounts.

The Affordable Care Act allowed states to expand their Medicaid programs in 2014 to low-income childless adults, and the federal government is paying nearly all the costs for those new beneficiaries. The new bill would scale the expansion back.

Sally Pipes, president of the San Francisco-based Pacific Research Institute, said the expansion of Medicaid was too costly and should have never been included in the ACA. “These programs are not sustainable, unless you are going to tremendously increase taxes on the middle class,” she said.

Pipes said Medicaid funding should be converted from entitlements into block grants and states should be left to decide how to structure their programs. “More and more people are thinking they are entitled to this and entitled to that and these programs are expensive and not efficient,” she said.

The cuts to Medi-Cal and the restructuring of the program will be better for the California economy, Pipes said.

Meanwhile, Gov. Jerry Brown, who was attending an anniversary celebration for the Affordable Care Act in Washington, D.C., had sharp words Wednesday for President Donald Trump and what he called his “fake health care bill.”

“In California, we’re not talking about a few thousand – we’re talking about millions of real people getting hurt – getting diseases that will not be cured – having heart attacks, not being able to go to a hospital or get a doctor,” the governor said in his prepared remarks.

California was among the most aggressive states in the nation in implementing the Affordable Care Act, and the majority of new enrollees came through Medi-Cal.

Medi-Cal now provides coverage to 13.5 million low-income residents, about half of California’s children and a third of the adults. About 3.7 million people of those became newly eligible for the publicly funded health coverage through the Medcaid expansion. That helped reduce the state’s uninsurance rate from 17 percent in 2013 to about 7 percent in 2016, according to the UC Berkeley Labor Center for Education and Research.

The Medicaid program is funded jointly by California and the federal government and provides health, dental, mental health, long-term care and other services.

The bill could put hospitals, clinics and other providers in a tenuous financial position by forcing them to live within the cost limits while at the same time seeing more uninsured patients, the analysis said.

The California Hospital Association did its own analysis and concluded that at least three million people would lose coverage under the GOP plan, and hospitals could see their bad debt and charity care increase by $3 billion per year.

“As more people lose coverage, they are still going to have health issues, and the hospital is the only place in the health care system required under federal law to provide care,” said Jan Emerson-Shea, vice president of external affairs for the association.

Health officials estimated that Medi-Cal costs would exceed per-capita caps by nearly $680 million in 2020, with the gap growing to $5.28 billion by 2027. That spending limit could have a “devastating and chilling effect” on any increases in provider payments or plan rates, according to the analysis.

The state also expects an additional $3.3 billion in costs in 2020, growing to $13 billion by 2027, because of a change that reduces federal funds for new enrollees and for people who have a break in coverage. The bill would require certain beneficiaries to renew coverage every six months rather than once a year, which state officials say will cause many to lose their coverage.

According to the analysis, the state would face additional losses from other federal cuts, including to a program that pays for in-home care for elderly and disabled residents. In addition, the proposed freeze on federal funding to organizations that provide abortions would make the state responsible for $400 million in payments to Planned Parenthood, which serves more than 600,000 people in Medi-Cal and a state family planning program.

A new study by UC Berkeley’s Labor Center released Wednesday also warned of dramatic cuts in federal Medi-Cal funding that would threaten coverage for low-income adults. The center estimated that the state would have to increase spending by $10 billion each year to maintain coverage for those who became eligible for coverage under the Affordable Care Act. Without that funding, the researchers wrote, 3.7 million people could lose coverage by 2027.

Ken Jacobs, chair of the center, said the Republican plan would also result in job losses because of reduced federal funding. Jacobs said both the center’s and the state’s calculations point to a significant financial impact on California if the GOP bill becomes law.

“It’s hard to see where else in the state budget this could be pulled from,” he said. “This would be a very big hit on the budget, the health system and the economy of California. … And the implications for people’s health are serious.”

 

 

This story was updated.

This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

8 Totally Doable Ways to Stay Healthyish When You're on the Go

Most days, you manage to slay your to-do list, tackle meal prep, and fit in a workout. But we all know life isn't always so predictable, and it's easy to let things spiral out of control when your days get crazed. (It happens to the best of us.)

But here's the bright side: It's actually a lot easier than it seems to incorporate healthyish habits when you're on the go. It's not about being perfect; it's just about being prepared. We asked some of the busiest health and fitness experts we know how they stay sane and on track when their schedules are all over the place. Steal their eight super-doable tips for yourself.

1. Make a healthy kit.

Photographed by Jessica Cain “Instead of cosmetics, I fill a makeup bag with items I can use on the go: a nonperishable snack like a protein-packed bar, essential oils, a resistance booty band, a recovery massage ball, headphones, and hair ties. Then, when I have a moment to myself, I can take time to either let stress out with some physical activity or turn my Zen on and recover.”—Jenna Arndt, group fitness instructor at Crunch 

2. Walk when you talk.

“My rule is no phone calls sitting down. I put in my earbuds and pace around the office or wall sit for each and every call I take during the day. To wall sit, step about a foot and a half away from a wall, then lean back and slide your torso down the wall until your thighs are near parallel to the floor—the lower you go, the harder you'll work. I have five to 10 calls a day, and some can last up to an hour. Staying on my feet is an amazing way to increase my calorie burn, and it gives me more energy for those conversations.”—Heather Peterson, chief yoga officer and instructor at CorePower Yoga

3. Make water taste better.

Photographed by Jessica Cain “Drinking enough water not only quenches my thirst, but also prevents me from feeling starved and fights fatigue and moodiness. It’s essential for me because I get hangry easily! I carry around a glass or BPA-free water bottle and sip from it throughout the day. I like the ones that come with a little portable infuser—I stick some lemon and sometimes herbs in there to add flavor.”—Carina Wolff, healthy food blogger at Kale Me Maybe

4. Stop. Breathe. Repeat.

“When I start to feel stressed, I remind myself to slow down and take a deep breath. It enables me to bypass the fight or flight response, so I can respond instead of react. Give it a try: Slowly inhale and count to 20 in your head. Exhale and repeat the process until you feel yourself return to a balanced state. This simple breathing exercise helps me re-center myself before a big moment or meeting. It's like a quick timeout in the middle of the day, no matter where you are.”—Khajak Keledjian, founder and CEO of Inscape, a meditation studio and app

Partner Reach for a healthy snack. Most protein bars are loaded with fake sugars and other artificial junk. Not this one. RXBARs are made with just a few clean, all-natural ingredients such as egg whites and nuts—and none of the bad stuff (every bar is gluten-free, soy-free, dairy-free, and added sugar-free). Plus, Greatist readers who are new to RXBAR get 25 percent off their first order! GET 25% OFF RXBAR NOW   5. Squeeze in a mini workout.

“When time is tight, try this 10-minute AMRAP (As Many Reps As Possible) workout. Keep the clock running and move at your own high-intensity pace, doing as many reps and rounds of this sequence as possible until the time is up: 30 jumping lunges, 20 crunches, 15 air squats, 10 push-ups, 5 triceps dips, repeat."—Arndt

6. Stash something sweet.

“I always carry dark chocolate—70 percent cocoa or higher with no or limited sugar—in my purse. It helps ward off afternoon sugar and coffee cravings and boosts my energy. If dark chocolate alone isn’t doing the trick to satisfy a sweet craving, I stick a little square into a date. It makes it sweeter, but I don’t feel bad for eating refined sugar! It’s like a mini dessert.”—Wolff

7. Use scents for stress relief.

Photographed by Jessica Cain “I keep calming essential oils like lavender or geranium in my work space to keep me feeling centered and calm even on the craziest days. I love using a chamomile lotion when I’m stressed too—it hydrates my skin and relaxes my mind while I’m stuck working at my desk most of the day.”—Danielle Cuccio, a private yoga instructor and founder and CEO of Cuccio Somatology

8. Set a step count PR. You might also like {{displayTitle}} READ

“I walk everywhere—to meetings, to workout studios, to meet friends, to grab lunch—instead of taking a cab or public transportation, regardless of whether I have worked out that day or not. I love being able to get the fresh air and the steps in—even if it is just 10 minutes. It makes me feel good and really changes my mindset on how I feel about myself and the choices I make for the rest of the day.”—Blair Flynn, a yoga teacher and healthy food blogger at Balance with B

7 Pho Recipes So Easy It's Like You've Made Them Before

Noodle soup is a comfort food found in almost every culture, whether it’s the all-American chicken noodle or Japanese ramen. Today, we’re focusing on a Southeast Asian favorite: pho (pronounced “fuh”). Brimming with rice noodles, herbs, and meat, pho recipes are flavor-packed one-pot meals most commonly found on the streets of Vietnam. But if a trip to Hanoi isn’t on the calendar anytime soon, here are seven easy, healthy ways to create the dish, from pho soups to beef pho, in your own kitchen.  

1. Spicy Chicken Pho Bowl Photo: My Digital Kitchen Jazz up your chicken dinner by throwing the meat in a soup bubbling with herby flavor and bulked up with brown rice noodles. It’s so much more exciting than just grilled chicken breast and veggies for so little extra work.  2. Spicy Shrimp Pho Photo: Chef Savvy Here’s the pho recipe for when you don’t have the cinnamon and anise on hand. Getting its flavor from garlic, jalapeño, and fish sauce, it may not be totally authentic, but the spicy kick will satisfy your craving anyway. 3. Pho With Zucchini Noodles Photo: Delish Plan It’s hard to decide what the best part of this beefy pho is: the zoodles that make it Paleo and gluten-free, the fragrant spiced broth they’re swimming in, the juicy sirloin that beefs up the dish, or the fact that it’s all ready in just 30 minutes. You be the judge. 4. Easy Awesome Vegan Pho Photo: Kimberly Snyder Take the express route to a comforting bowl of pho with this vegan recipe. Mushrooms add a ton of meaty texture, and carrots lend even more fiber. You’ll be slurping away happily in less than half an hour. 5. Quick and Easy Homemade Pho Photo: The Girl on Bloor Just the simple step of marinating the steak in red curry paste adds a whole new level of flavor to this fast and easy soup. Combined with the broth, it becomes a cross between a Vietnamese pho and a Malaysian laksa, and the result is delicious.  6. Vietnamese Pho With Tofu and Mushrooms Photo: Sophia Von Porat While the cinnamon, cloves, and star anise keep this recipe true to a traditional pho, additions such as tofu for vegetarian protein and peanuts for crunch make it both filling and fun. You may very well prefer this over the meat version.  7. Slow Cooker Chicken Pho Photo: Young Broke and Hungry The secret to really fantastic pho is letting the meat and soup simmer in all those herbs and spices for as long as possible. For those of us who don’t have the time to watch a pot for hours, this slow-cooker version gives you all that depth of flavor for minimal effort, just the way we like it. 

 

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