Indiana, Pence’s Home State, Seeks Federal OK To Keep Medicaid Expansion

As Congress weighs repeal of the Affordable Care Act, the home state of Vice President Mike Pence Tuesday sought to keep its conservative-style Medicaid expansion under the federal health law.

Indiana applied to the Trump administration to extend a regulatory waiver and funding until Jan. 31, 2021, for its innovative package of incentives and penalties that are intended to encourage low-income Hoosiers on Medicaid to adopt healthy behaviors. Beneficiaries pay premiums, get health savings accounts and can lose their benefits if they miss payments.

Though Pence now supports the health law’s repeal, the Healthy Indiana Plan that he established in 2015 as the state’s governor has brought Medicaid coverage to more than 350,000 people. The architect of the plan was health care consultant Seema Verma, who has been nominated to head the Centers for Medicare & Medicaid Services.

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Without Trump administration approval, federal money for Indiana’s expansion will run out Jan. 31, 2018. Indiana officials said the Medicaid expansion would continue even if Washington follows through on a Republican proposal to distribute federal Medicaid funds through a block grant program that would give states more flexibility in setting benefits and eligibility levels.

State officials refused to say whether the expansion would continue if Congress repealed Obamacare and eliminated funds for Medicaid expansions. If that happened, it’s unlikely states would have the money to make up for the lost federal aid.

Indiana’s effort to continue its Medicaid expansion demonstrates how states that expanded Medicaid under the Affordable Care Act — even Republican-controlled ones — are counting on additional federal dollars to pay for those expansions. It also reflects deadline pressure: They can’t wait for Congress to finish its debate over the future of the health law because they need to set budgets and programs now for next year.

According to Indiana’s request, continuing the Medicaid expansion will cost Indiana $1.5 billion but bring $8.6 billion in federal funding from 2018 to 2020.

“Indiana has built a program that is delivering real results in a responsible, efficient, and effective way,” Gov. Eric Holcomb, a Republican, said in a statement. “I look forward to maintaining the flexibility to grow this remarkably successful tool and to preserve our ability to respond to the unique needs of Hoosiers.”

Several other states including Kentucky and Ohio are considering adopting features of Indiana’s Medicaid plan.

Tuesday’s filing continues most core elements of the Healthy Indiana Plan, but also expands beneficiaries access to substance abuse treatment and adds incentives for members to quit smoking, use chronic disease management programs and take part in voluntary job referral and training programs.

“Certainly I think the new administration would give the waiver a friendly reception,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “But again that doesn’t answer the question about whether the money is going away,” if Congress repeals the health law and the Medicaid expansion.

Rep. Susan Brooks, R-Ind., broke the news of the waiver submission plans at a House committee hearing on Medicaid on Tuesday.

“It’s an outstanding program that I hope folks on both sides of the aisle see it is a way to save and help people who truly need it, and it can be replicated,” Brooks said.

Some Republican plans to scrap and replace the Affordable Care Act don’t include a Medicaid expansion. Republicans have argued for years that the Medicaid program is broken and non-disabled adults who gained coverage under the expansion should not be covered.

Under expansion, states received additional federal funding to expand eligibility to everyone with annual incomes at or below 138 percent of the federal poverty level, or about $16,000.

Holcomb isn’t the only Republican governor counting on Medicaid expansion and the additional federal funding continuing at least through 2018.

Ohio Gov. John Kasich proposed a budget Monday that maintains expansion coverage for 700,000 individuals.

But Kasich plans to switch from a traditional Medicaid expansion to a more conservative version that will require beneficiaries to pay more out of pocket.

Categories: Medicaid, Repeal And Replace Watch, Syndicate, The Health Law


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Democrats Say Cabinet Choice Tom Price ‘Misled’ The Public. Here’s What We Know.

Republicans on the Senate Finance Committee Wednesday morning pushed through the nomination of Rep. Tom Price without any Democratic votes. The Senate Democrats have been asking for more time to look into questions that he may have misled the public about issues in his financial background.

Here are some of the issues still swirling around Price:

Insider deal or just good fortune? Kaiser Health News reported Jan. 13 that Price got a sweetheart deal in 2016 on a penny stock in an Australian drug company, and Democrats grilled him about it at his confirmation hearing. The Georgia Republican said he first invested in the company after discussing it in 2014 with Rep. Chris Collins, R-N.Y., a major stakeholder in Innate Immunotherapeutics. The opportunity to buy more stock in a private placement was “available to every single individual that was an investor at the time,” Price testified. His account was called into question again Monday in a Wall Street Journal report. Company chief executive Simon Wilkinson confirmed that a limited number of U.S. investors were offered the private placement, which was discounted by 12 percent, according to company documents. U.S. investors who bought in included Price, Collins, Collins’ chief of staff and a former Buffalo congressman, records show. Senate Democrats want more details.

How much was the stock really worth? Price testified that he fully disclosed his Innate Immunotherapeutics investments to the House Ethics Committee. Yet the Senate Finance Committee staff discovered in its review that he had undervalued his stock holdings and asked him to correct the filing. Records show Price upped his estimate of the stock’s value from $50,000 to $100,000, as reported in a December disclosure, to the actual market value of $100,000 to $250,000. Price called the discrepancy a “clerical error.”

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An ethics probe that Price forgot to mention: Price checked “no” when asked in a Senate Finance Committee questionnaire if he had ever been subject to an ethics complaint or investigation. But the committee staff reminded him that he had. In 2010, the Office of Congressional Ethics looked into a lunch hosted by Price’s campaign committee, offering one-on-one meetings between Price and lobbyists working on a financial reform bill that the congressman would vote on the next day. The ethics office referred the issue to the House Ethics Committee to determine whether Price improperly solicited campaign funds. The House Ethics Committee found no wrongdoing in 2011. Price said answering “no” was an inadvertent mistake.

Intervening with health officials, including for a top campaign contributor: Price has written dozens of letters to the Centers for Medicaid & Medicare and the Food and Drug Administration, and scheduled phone calls on issues as diverse as stem cell treatment oversight to a hot pepper ingredient in pain creams. One intervention was for a Georgia company that later became a top campaign contributor, Kaiser Health News reported last week. Price wrote to CMS administrator Marilyn Tavenner concerning the reimbursement for a skin graft made by a biotech company in his district, MiMedx. The Medicare pay raise that followed was a “real win” for the company that uses discarded placentas to make wound-healing products, according to the company CEO’s statements to investors. Asked about the matter, an HHS spokesman and former Price staffer defended the lawmaker as only acting “to improve the lives of American people.”

 Did Price’s actions boost the value of his investments? Senate Democrats have questioned whether Price took official actions that could boost the value of health stocks in his portfolio. Time Magazine reported that Price bought as much as $90,000 in stock in six pharmaceutical firms before leading a legislative effort that would benefit the companies’ bottom line. Also, CNN reported that Price invested in the medical device firm Zimmer Biomet before leading another legislative push that could have helped that firm. Price’s team has disputed the CNN account. Price maintains that all of his investments were picked by his broker, with one exception — Innate Immunotherapeutics.

Democratic lawmakers, meanwhile, wrote a letter Monday calling on Price to provide communications on the stock buys and documents that would “determine how much control he actually exercised over his investments in the health care sector.”

This article was updated to note the Finance Committee vote Wednesday.

Categories: Health Industry, Repeal And Replace Watch, Syndicate


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Bilingual People May Have an Edge Against Alzheimer's

News Picture: Bilingual People May Have an Edge Against Alzheimer'sBy Dennis Thompson
HealthDay Reporter

Latest Alzheimers News

MONDAY, Jan. 30, 2017 (HealthDay News) — People who speak two or more languages appear to weather the ravages of Alzheimer’s disease better than people who have only mastered one language, a new Italian study suggests.

Bilingual people with Alzheimer’s outperformed single-language speakers in short- and long-term memory tasks, even though scans showed more severe deterioration in brain metabolism among the bilingual participants, the scientists said.

The ability to speak two languages appears to provide the brain with more resilience to withstand damage from Alzheimer’s, said lead researcher Dr. Daniela Perani, a professor of psychology at Vita-Salute San Raffaele University in Milan.

The more often a person swapped between two languages during their lifetime, the more capable their brains became of switching to alternate pathways that maintained thinking skills even as Alzheimer’s damage accumulated, the researchers found.

Previous studies have shown that lifelong bilingualism can delay the onset of dementia by as much as five years, Perani said. However, no one has yet examined what causes that effect in the brain.

To examine this more closely, Perani and her colleagues performed brain scans and memory tests on 85 seniors with Alzheimer’s. Among the participants, 45 spoke both German and Italian, while 40 only spoke one language.

The bilingual people dramatically outscored monolingual speakers on memory tests, scoring three to eight times higher, on average.

Bilingual people achieved these scores even though scans of their brains revealed more signs of cerebral hypometabolism — a characteristic of Alzheimer’s in which the brain becomes less efficient at converting glucose into energy.

The brain scans also provided a clue why this might be. People who were bilingual appeared to have better functional connectivity in frontal brain regions, which allowed them to maintain better thinking despite their Alzheimer’s, Perani said.

Constantly using two languages appears to make the brain work harder. During a lifetime this causes structural changes to the brain, creating a “neural reserve” that renders the bilingual brain more resistant against aging, Perani said.

Bilingualism also sets up a person for better “neural compensation,” in which the brain copes with its own degeneration and loss of neurons by finding alternative pathways through which to function, she said.

“Our finding suggests that in bilingual patients with Alzheimer’s dementia both mechanisms are at play, since neuronal loss is accompanied by compensatory increase of connectivity, allowing bilingual patients to maintain high neuropsychological performance and cognitive functioning longer than monolingual [patients],” Perani said.

Heather Snyder, senior director of medical and scientific operations for the Alzheimer’s Association, said these results make sense given what is known about the aging brain.

“It’s that idea of cognitive engagement — continuing to use it or you lose it,” Snyder said. “People who are bilingual and are going back and forth with two different languages throughout their day are activating a specific way of thinking that’s making those brain connections.”

“It’s a small study, so you can’t draw too many conclusions from it, but it is the kind of research we do want to see more of,” Snyder added.

The study also suggests that kids who learn a second language and use it often will benefit in their old age, Perani said.

“Considering that delaying the onset of dementia is a top priority of modern societies, governments and health systems should be stimulated to activate social programs and interventions to support bilingual or multilingual education, and to maintain the use of more languages in aging,” she said.

Understanding these Alzheimer’s-resistant brain mechanisms could also lead to future therapies where medications and lifestyle changes are combined to protect seniors’ minds, Snyder said.

The new study was published Jan. 30 in the Proceedings of the National Academy of Sciences.

Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Daniela Perani, M.D., professor, psychology, Vita-Salute San Raffaele University, Milan, Italy; Heather Snyder, Ph.D., senior director, medical and scientific operations, Alzheimer’s Association; Jan. 30, 2017, Proceedings of the National Academy of Sciences

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Busy Minds May Be Better at Fighting Dementia

News Picture: Busy Minds May Be Better at Fighting DementiaBy Dennis Thompson
HealthDay Reporter

Latest Alzheimers News

MONDAY, Jan. 30, 2017 (HealthDay News) — Mentally stimulating activities can protect your brain against aging, even if you’re genetically predisposed toward dementia or Alzheimer’s disease, a new study reports.

Activities that keep the brain busy — using a computer, crafting, playing games and participating in social activities — appear to lower the risk of age-related mental decline in people 70 and older, the Mayo Clinic study found.

“These kind of commonly engaged in, stimulating activities actually reduce the risk of people developing mild cognitive impairment,” said co-author Dr. Ronald Petersen. He’s director of the Mayo Clinic Alzheimer’s Disease Research Center in Rochester, Minn.

The researchers found the benefits of mental stimulation even helped people who have apolipoprotein E (APOE) E4, a genetic risk factor for dementia and Alzheimer’s.

For their study, Mayo researchers followed more than 1,900 mentally healthy men and women participating in the Mayo Clinic Study of Aging for four years on average. Their average age when the study began was 77.

During that period, more than 450 participants developed mild cognitive impairment — a slight but noticeable decline in memory and thinking skills that may be the first step toward developing dementia or Alzheimer’s disease.

Although the study wasn’t designed to prove a cause-and-effect relationship, those who regularly engaged in certain mind-stimulating activities had a lower risk of memory and thinking troubles. For example, researchers saw this risk go down by:

  • 30 percent with computer use,
  • 28 percent with crafting activities,
  • 23 percent with social activities,
  • 22 percent with playing games.

The researchers found that people who performed these activities at least one to two times per week had less decline in memory and thinking skills than people who did these activities only two to three times per month or less, noted senior author Dr. Yonas Geda, in a Mayo news release. Geda is a psychiatrist and behavioral neurologist at Mayo Clinic’s Arizona campus.

Reading books and newspapers regularly didn’t seem to confer the same benefits for thinking and memory, the study suggested.

People with the APOE E4 genetic risk factor received some protection from mental decline if they engaged in computer use or social activities, the researchers added.

A good brain workout appears to require different levels of intellectual stimulation, such as thinking out problems in your mind and then manipulating objects to create the solution, Petersen said.

“Think of operating a computer, especially for an older person,” he said. “It can be challenging. Things always go wrong, and you have to problem-solve to figure out why something didn’t work like it should have.”

Crossword and sudoku puzzles probably are good brain exercises as well, Petersen said, although he said this research shouldn’t be read as a direct endorsement of online brain training programs such as Lumosity or BrainHQ.

“I’m not saying that your brain game isn’t good for people, but I’m not endorsing it at all,” Petersen said of such online programs. “We can’t say your exercises are the same thing as what we found in this, but it’s not an unreasonable connection.”

Dr. Paul Wright is chair of neurology for North Shore University Hospital in Manhasset, N.Y., and Long Island Jewish Medical Center in New Hyde Park, N.Y. He said the new study provides geriatric doctors with more evidence to convince patients that brain workouts are important for healthy aging.

“This way we can actually tell our patients with mild cognitive impairment that there is evidence now that if you stay mentally active, you will actually do much better than if you don’t,” Wright said.

These exercises also need to involve “not just looking at something, but the interaction with your vision and your hands and movement,” he added.

On a final note, Petersen warned that people shouldn’t turn these activities into daily drudge work.

“You don’t want to do 10 crossword puzzles a day like going to the gym and walking around the track for an hour,” he said. “As you age, try not to withdraw, try not to slow down intellectually. Stay engaged out there. Do things you enjoy, and it will be fun. If you enjoy doing something, do it, and do it avidly because it might in fact be beneficial to you.”

The study was published Jan. 30 in the Journal of the American Medical Association.

Copyright © 2017 HealthDay. All rights reserved.

SOURCES: Ronald Petersen, M.D., Ph.D., director, Mayo Clinic Alzheimer’s Disease Research Center, Rochester, Minn.; Paul Wright, M.D., chair of neurology, North Shore University Hospital, Manhasset, N.Y., and Long Island Jewish Medical Center, New Hyde Park, N.Y.; Jan. 30, 2017, Journal of the American Medical Association

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This Valentine’s Day, give your heart the gift of love

Although popular love songs might tell you otherwise, a broken heart can’t kill you—but heart disease can. Heart disease is the leading cause of death in the United States for both men and women, taking about 610,000 lives each year—that’s 1 in every 4 deaths.

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and help prevent heart disease. Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease.

Medicare covers a cardiovascular disease screening at no cost to you every 5 years. The screening includes tests to help detect heart disease early and measures cholesterol, blood fat (lipids), and triglyceride levels.

If you and your doctor discover that you’re at risk for a heart attack or stroke, there are steps you can take to help prevent these conditions. You might be able to make lifestyle changes (like changing your diet and increasing your activity level or exercising more often) to lower your cholesterol and stay healthy.

February is American Heart month, so start showing your heart love by visiting the Million Hearts® Healthy Eating & Lifestyle Resource Center. Million Hearts is a national initiative to prevent 1 million heart attacks and strokes by the end of this year. The resource center was developed in partnership with EatingWell magazine, and features lower sodium, heart-healthy recipes and family-friendly meal plans to help manage sodium intake, a major contributor to high blood pressure and heart disease. All the recipes include nutritional facts and average cost per serving information. Use the search and filter options to quickly find the right meal for yourself and your family.

While you’re celebrating family and friends this Valentine’s Day, don’t forget to show your heart some love, too.

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