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Are you confused about Obamacare? KQED and The California Report created a guide to help answer your questions about the Affordable Care Act.

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As many as 18,000 Kaiser Permanente nurses are preparing for a two-day strike that starts Tuesday in Northern California. Despite three months of contract negotiations, there are few areas of agreement.

PBS NewsHour

Nearly a quarter of uninsured say they can’t afford coverage, poll finds

Counselors Amelia Kupchyk, L, and Vanessa Gomez, R, help clients with computer work required to navigate the second round
         of open enrollment for the Affordable Care Act as HHS Secretary Sylvia Burwell tours the Greater Prince William Community
         Health Center in Manassas, VA on Nov. 15, 2014. Photo by Linda Davidson/The Washington Post

Counselors Amelia Kupchyk, L, and Vanessa Gomez, R, help clients with computer work required to navigate the second round of open enrollment for the Affordable Care Act as HHS Secretary Sylvia Burwell tours the Greater Prince William Community Health Center in Manassas, VA on Nov. 15, 2014. Photo by Linda Davidson/The Washington Post

Just days before the health law’s marketplaces reopened, nearly a quarter of uninsured said they expect to remain without coverage because they did not think it would be affordable, according to a poll released Friday.

That was by far the most common reason given by people who expect to stay uninsured next year, according to the latest tracking poll by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) Forty-one percent of individuals without health insurance said they expected they would remain uninsured, while about half said they plan to get coverage in the coming months.

The law includes subsidies to reduce premium costs and cost-sharing assistance for those who qualify, although it was not clear if the uninsured knew that.kaiserpoll3Despite heavy news coverage and marketing from insurers about the re-opening of enrollment, about 9 in 10 of the uninsured said they didn’t know when the health law’s open enrollment period began (Nov. 15). That was similar to the findings in last month’s Kaiser poll.

More than 8 in 10 of the uninsured said it is at least somewhat important to them to have health insurance, with 62 percent saying it’s very important. Seven in 10 said health insurance is something they need.

Other findings in Kaiser’s November poll include that most of the public reports their families have not been directly impacted by the health law, with more (24 percent) saying they have been hurt than helped (16 percent).

Forty-six percent of those surveyed hold an unfavorable view of the law and 37 percent view it favorably, a slight change from last month’s survey, where 43 percent of those questioned held an unfavorable view of the law and 36 percent a favorable one. Despite heavy news coverage and marketing from insurers about the re-opening of enrollment, about 9 in 10 of the uninsured said they didn’t know when the health law’s open enrollment period began (Nov. 15).

With the midterm elections giving Republicans control of the Senate and increasing the party’s majority in the House of Representatives, Americans were divided about whether the debate between the two parties over the health law would increase, the poll found. Forty-seven percent expected it, while 42 percent predicted it would stay at about the same level.

There’s a variety of opinion about what Congress should do next with the health law. Twenty-nine percent of the public supports the law’s repeal, 17 percent favors scaling the law back, 20 percent wants the law to move ahead as is, while 22 percent chooses expanding the law.

Republicans are more likely to favor repeal (52 percent) or scaling it back (24 percent), while Democrats are more likely to favor moving ahead with the law in its current form (40 percent) or expansion (34 percent). Independents fall in between, but lean toward repeal or scaling back.

The poll was conducted from Nov. 5 through 13, using a telephone sample of 1,501 adults. The margin of error is +/- 3 percentage points for the full sample and +/- 9 percentage points for the uninsured.

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente. Jay Hancock contributed to this report.

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How does space affect men and women differently?

On Earth, human bodies share many similarities, yet also possess many differences, including factors influenced by both sex and gender. However, what happens to those factors when you put the human body in space?

A study assembled by NASA, in partnership with the National Space Biomedical Research Institute, compiled years of published and unpublished human spaceflight data in order to examine the physiological and psychological changes during spaceflight between sexes and genders. The data was given to six workgroups, who focused on “cardiovascular, immunological, sensorimotor, musculoskeletal, reproductive and behavioral implications on spaceflight adaptation for men and women.”

The compendium of the groups’ research, “Impact of Sex and Gender on Adaptation to Space”, was published in the Journal of Women’s Health this month. The result, NASA says, is the “most current, comprehensive report on sex and gender differences related to human physiology and psychology in spaceflight and on Earth.”

The groups found no direct evidence of differences between the sexes when examining behavioral or psychological responses during spaceflight, as well as no differences of “neurobehavioral performance and sleep measures.” Yet, the groups did find several physiological differences.

In their research, however, the groups made note that it was difficult to come to a concrete conclusion on sex and gender data alone due to the disparity between available data for spacefaring men and women. As of June 2013, 477 men have made it to space as opposed to 57 women, prompting the groups to recommend the selection of more female astronauts for space-based missions.

NASA summarized the study’s findings on their website:

The Sex & Gender work groups released five recommendations:

  • Select more female astronauts for spaceflight missions.
  • Encourage and facilitate the participation of more female and male subjects in both ground and flight research studies.
  • Focus on the responses of individual astronauts to spaceflight and return to Earth.
  • Include sex and gender factors in the design of the experiments.
  • Incorporate sex and gender and other individual risk factors into NASA-funded research programs.

A summary of the Sex & Gender work groups’ major findings is listed below:

  • Orthostatic Intolerance, or the inability to stand without fainting for protracted periods, is more prevalent upon landing in female astronauts than in their male counterparts. One possible reason for this observed difference in orthostatic intolerance between the sexes is reduced leg vascular compliance, which was demonstrated in bed-rest studies – which is a ground analog for spaceflight.
  • Women have greater loss of blood plasma volume than men during spaceflight, and women’s stress response characteristically includes a heart rate increase while men respond with an increase in vascular resistance. Still, these Earth observations require further study in space.
  • The VIIP syndrome (visual impairment / intracranial pressure) manifests with anatomical ocular changes, ranging from mild to clinically significant, with a range of corresponding changes in visual function. Currently 82% of male astronauts vs. 62% of women astronauts (who have flown in space) are affected. However, all clinically significant cases so far have occurred in male astronauts.
  • Changes in function and concentration of key constituents of the immune system related to spaceflight have been reported. However, differences between male and female immune responses have not been observed in space. On the ground, women mount a more potent immune response than men, which makes them more resistant to viral and bacterial infections; once infected, women mount an even more potent response. This response, however, makes women more susceptible to autoimmune diseases. It is not clear if these changes on the ground will occur during longer space missions, or missions that involve planetary exploration (exposure to gravity).
  • Radiation presents a major hazard for space travel. It has been reported that female subjects are more susceptible to radiation-induced cancer than their male counterparts; hence radiation permissible exposure levels are lower for women than men astronauts.
  • Upon transition to microgravity after arriving at the International Space Station (ISS), female astronauts reported a slightly higher incidence of space motion sickness (SMS) compared with men. Conversely, more men experience motion-sickness symptoms upon return to Earth. These data were however not statistically significant, due both to the relatively small sample sizes and small differences in the incidence of SMS reported by the men and women astronauts.
  • Hearing sensitivity, when measured at several frequencies, declines with age much more rapidly in male astronauts than it does in female astronauts. No evidence suggests that the sex-based hearing differences in the astronaut population are related to microgravity exposure.
  • The human musculoskeletal response to gravity unloading is highly variable among individuals and a sex-based difference was not observed.
  • Urinary tract infections in space are more common in women and have been successfully treated with antibiotics.
  • There is no evidence of sex differences in terms of behavioral or psychological responses to spaceflight. Analysis of ISS astronauts’ neurobehavioral performance and sleep measures showed no sex or gender differences using the Psychomotor Vigilance Test (PVT) of alertness and Visual Analog Scales of workload, stress and sleep quality. Since all all astronaut candidates undergo a robust process of psychological screening and selection, the likelihood of an adverse behavioral health condition or psychiatric disorder is greatly diminished.



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Texting may be ruining your back

Photo by Flickr user Garry Knight

A new study says tilting your neck while texting may be harming your back. Photo by Flickr user Garry Knight

Do you tilt your head down while texting on your cellphone? Chances are you may be damaging your back in the process, according to new study.

Research published this week in Surgical Technology International by New York spinal surgeon Kenneth Hansraj says that the simple act of looking down at a cellphone exerts enormous pressure on the neck. Using a computer-designed model of a human spine, Hansraj tested the amount of pressure generated on the back in associated with how far forward the head was tilted. The amount intensified the greater the angle: a 15-degree tilt put 27 pounds of pressure on the spine, while a 60-degree tilt left the back handling 60 pounds.

With people spending an average of two to four hours a day looking down at their cellphones, the study says, the user can accumulate between 700 and 1400 hours of extra spinal pressure per year.

However, Hansraj said it doesn’t mean people should stop texting.

“While it is nearly impossible to avoid the technologies that cause these issues,” Hansraj wrote in the study, “individuals should make an effort to look at their phones with a neutral spine and to avoid spending hours each day hunched over.

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69 years ago, a president pitches his idea for national health care

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri. Former
         President Harry S. Truman is seated at the table with President Johnson. In the background from right to left: Senator Edward
         V. Long, an unidentified man, Lady Bird Johnson, Senator Mike Mansfield, Vice President Hubert Humphrey, and Bess Truman.
         Archive photo from the White House Press Office

President Lyndon B. Johnson signing the Medicare Bill at the Harry S. Truman Library in Independence, Missouri, with President Truman seated next to him. Twenty years earlier, President Truman proposed his idea for nationwide health care. Archive photo from the White House Press Office

This past July 30, we celebrated the 49th anniversary of Medicare and Medicaid. Readers of this column will recall it was on that date in 1965 when President Lyndon Baines Johnson formally signed these two programs into law in Independence, Missouri, as former president Harry S. Truman and his steadfast wife, Bess, looked on with pride. As LBJ handed “Give ‘Em Hell Harry” and Bess the pens he used to affix his signature to the document, the President proclaimed Mr. Truman as “the real daddy of Medicare.”

"Harry S Truman, bw half-length photo portrait, facing front, 1945" by Edmonston Studio - The Library of Congress, Licensed under Public domain via Wikimedia Commons -

President Harry S. Truman proposed a universal health care program in 1945. Photo by Edmonston Studio — The Library of Congress

Today marks the reason why LBJ bestowed such presidential credit to Harry Truman.

Back in 1945 — a mere seven months into a presidency he inherited from Franklin D. Roosevelt — Truman proposed a “universal” national health insurance program. In his remarks to Congress, he declared, “Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.”

69 years ago, President Truman outlined five critical goals of national health.

The first was to address the number and disparity of physicians, nurses and other health professionals, especially in low-income and rural communities where there were “no adequate facilities for the practice of medicine” and “the earning capacity of the people in some communities makes it difficult if not impossible for doctors who practice there to make a living.” To begin to correct this problem, Truman wanted the federal government to construct modern, quality hospital across the nation—especially where they did not yet exist.

The second issue was the need to develop and bolster public health services (both to control the spread of infectious diseases and improve sanitary conditions across the nation) and maternal and child health care. With respect to the latter, Harry Truman reminded Congress, “the health of American children, like their education, should be recognized as a definite public responsibility.”

Third, he sought to increase the nation’s investment in both medical research and medical education.

The fourth problem addressed the high cost of individual medical care. “The principal reason why people do not receive the care they need,” Truman noted, “is that they cannot afford to pay for it on an individual basis at the time they need it. This is true not only for needy persons. It is also true for a large proportion of normally self-supporting persons.”

And fifth, he focused on the lost earnings that inevitably occur when serious illness strikes. “Sickness,” Truman cogently explained, “not only brings doctor bills; it also cuts off income.

Not surprisingly, it was President Truman’s proposal to fix the 4th and 5th problems with a national health insurance plan that provoked the loudest opposition. Truman proposed that every wage earning American pay monthly fees or taxes to cover the cost of all medical expenses in time of illness. The plan also called for a cash balance to be paid to policyholders, in the event of injury or illness, to replace the income those individuals lost.

His measured and careful description of the plan merits quoting:

“Under the plan I suggest, our people would continue to get medical and hospital services just as they do now — on the basis of their own voluntary decisions and choices. Our doctors and hospitals would continue to deal with disease with the same professional freedom as now. There would, however, be this all-important difference: whether or not patients get the services they need would not depend on how much they can afford to pay at the time…None of this is really new. The American people are the most insurance-minded people in the world. They will not be frightened off from health insurance because some people have misnamed it ‘socialized medicine.’ I repeat — what I am recommending is not socialized medicine. Socialized medicine means that all doctors work as employees of government. The American people want no such system. No such system is here proposed.”

The Truman plan was quickly converted into a Social Security expansion bill sponsored by Sens. Robert Wagner (D-NY) and James Murray (D-MT) and Rep. John Dingell Sr. (D-MI). A version of this bill had been proposed in 1943, when FDR was still president, but died in committee both because of the pressures of the war and the lack of presidential pressure on Congress.

At first, things looked somewhat rosy for the reinvigorated 1945 bill: the Democrats still controlled both the House of Representatives and the Senate and a number of prominent Americans vociferously supported it. Still, the nation was weary from war, the high taxes necessary to pay for FDR’s New Deal, and what many Americans perceived to be a too intrusive federal government.

Almost as soon as the reinvigorated bill was announced, the once-powerful American Medical Association (AMA) capitalized on the nation’s paranoia over the threat of Communism and, despite Truman’s assertions to the contrary, attacked the bill as “socialized medicine.” Even more outrageous, the AMA derided the Truman administration as “followers of the Moscow party line.” During congressional hearings in 1946, the AMA proposed its own plan emphasizing private insurance options, which actually represented a political shift from its previous position opposing any third party members in the delivery of health care.

Another historical actor entering the fray was Senator Robert Taft (R-OH), who introduced the Taft-Smith-Ball bill, which called for matching grants to states to subsidize private health insurance for the needy. Although the AMA supported this bill, Truman was against it because he believed it would halt the political progress he had made in guaranteeing every American health insurance.

Hearings and politics continued through 1946 but little progress was made. During the midterm elections of 1946, the Republicans regained control of both the Senate and the House for the first time since 1929, making the bill a dead issue.

Harry Truman continued to make health insurance a major issue of his campaign platform in 1948 and specifically castigated the AMA for calling his plan “un-American”:

“I put it to you, it is un-American to visit the sick, aid the afflicted or comfort the dying? I thought that was simple Christianity.”

Truman famously fooled the pollsters by winning re-election in 1948 and even the Congress was restored to Democratic control that fall. But this political power was no match for the AMA’s redoubled lobbying and advertising efforts, which were endorsed by more than 1,800 national organizations, including the American Bar Association, the American Legion and the American Farm Bureau Federation. Public support waned — and the bill quietly died (again) — as the middle class purchased private health insurance plans, labor unions began collectively bargaining for their members’ health benefits, and the advent of the Korean War.

Truman later called the failure to pass a national health insurance program one of the most bitter and troubling disappointments in his presidency. He must have been overjoyed in 1965 to watch Lyndon Johnson enact a health insurance plan for the elderly and the needy. Nevertheless, the nation would have to wait another 45 years before the passage of the Patient Protection and Affordable Care Act of 2010, a law that remains in jeopardy after Nov. 7, when the U.S. Supreme Court took on still another legal challenge to its constitutionality. That said, many would insist there remains a great more work to do to make health care affordable and accessible for all Americans.

         Howard Markel

Dr. Howard Markel

Dr. Howard Markel writes a monthly column for the PBS NewsHour, highlighting the anniversary of a momentous event that continues to shape modern medicine. He is the director of the Center for the History of Medicine, the George E. Wantz Distinguished Professor of the History of Medicine at the University of Michigan, and editor-in-chief of the Milbank Quarterly.

He is the author or editor of 10 books, including “Quarantine! East European Jewish Immigrants and the New York City Epidemics of 1892,” “When Germs Travel: Six Major Epidemics That Have Invaded America Since 1900 and the Fears They Have Unleashed” and “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.”

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