WASHINGTON (AP) ? Nearly 2 in 3 uninsured low-income people who would qualify for subsidized coverage under President Barack Obama's health care law may be out of luck next year because their states have not expanded Medicaid.
An Associated Press analysis of figures from the Urban Institute finds a big coverage gap developing, with 9.7 million out of 15 million potentially eligible adults living in states that are refusing the expansion or are still undecided with time running short.
That a majority of the neediest people who could be helped by the law may instead remain uninsured is a predicament unforeseen by Obama and congressional Democrats who designed a sweeping extension of the social safety net. The law's historic promise of health insurance for nearly all U.S. residents would not be fulfilled as envisioned.
It's the direct consequence of last summer's Supreme Court decision that gave states the right to opt out of the Medicaid expansion, combined with unyielding resistance to the law from many Republican state lawmakers.
Expanding Medicaid is essential to Obama's two-part strategy for covering the uninsured.
Starting next year, middle-class people without job-based coverage will be able to get tax credits to help them buy private insurance. But the law calls for low-income people to enroll in Medicaid, expanded to accommodate a largely excluded group: adults with no children at home. Expanded Medicaid would cover about half the 25 million to 30 million people who could be helped by the law.
Twenty-three states and the District of Columbia have decided to accept the expansion, which is fully financed by Washington for the first three years and phases down gradually to a 90 percent federal share.
Among those are six states led by Republican governors. But the majority of low-income Americans newly eligible for Medicaid under the law live in states such as Texas, Florida and Georgia, where political opposition remains formidable.
"Because of the Supreme Court's decision making Medicaid expansion optional with the states, we're going to see some pretty significant differences in this country from one place to another in terms of access to health care and access to health insurance," said Gary Cohen, the Health and Human Services official overseeing the rollout of the law.
Speaking this past week at the Brookings Institution, Cohen added: "We are going to have an opportunity ... to take a look at that in a year and see what difference it made, the choices that were made at the political level to do one thing rather than another.
"And that's going to be a pretty profound difference and a pretty profound choice that we get to make every couple of years about what kind of country we want to be," Cohen continued.
Elections for state offices and Congress will be held next year.
Republican state lawmakers continue to oppose the expansion for several reasons. Many believe Medicaid has too many problems already. Others worry that Washington will renege on financing, and some believe health care is an individual responsibility, not a government obligation.
"It's an ideological principle piece to us on the conservative side," David Gowan, Arizona's Republican House majority leader said recently. "We don't believe in the expansion of Medicaid itself. ... We don't believe it's the government's duty to do that." Gov. Jan Brewer, also a Republican, succeeded in getting the Arizona Medicaid expansion through the Legislature but now faces the possibility of a referendum to block the law.
GOP health policy expert Gail Wilensky says she did not expect so many states to turn down the Medicaid expansion. While critical of some main features of the Affordable Care Act, Wilensky believes it's important for the country to get uninsured people covered.
"For me, it is really is quite surprising ? particularly in the years with 100 percent federal funding ? that so many states are saying 'no,'" Wilensky said. "This is depriving the poorest of their citizens of an important benefit." Wilensky ran Medicare and Medicaid during the George H.W. Bush administration.
The AP's continuing check of the states finds 18 not expanding and nine where the outcome is still undecided. The biggest states where the expansion is stymied are Texas, with 1.7 million potentially eligible residents; Florida, with 1.3 million, and Georgia, with more than 680,000.
Still trying to find a path forward are Michigan and Ohio, whose Republican governors support the expansion but face legislative opposition. Each has more than one-half million potentially eligible residents, according to the Urban Institute, a public policy research center.
Health and Human Services Secretary Kathleen Sebelius says she hopes that holdouts will have a change of heart.
"The door is open," said Sebelius. "If a legislature decides to reconvene at the beginning of January, and change their law, then we would welcome them in."
There is no deadline for states to decide. Next year states will have an opportunity in each calendar quarter, and if they later want to drop out they can do that.
Low-income residents of states refusing the expansion will be exempted from tax penalties for being uninsured. Those penalties also take effect next year, when virtually everyone in the country will be required to have health insurance.
Medicaid already covers more than 60 million people, including many elderly nursing home residents, severely disabled people of any age and many low-income children and their mothers.
An earlier Urban Institute analysis of the expansion found that less than $100 billion in state spending could trigger nearly $1 trillion in federal dollars over a decade.
As originally designed, the expansion was supposed to cover households making up to 138 percent of the federal poverty level, about $15,860 for an individual or $32,500 for a family of four.
Under the law, Medicaid is the only coverage option for people below the poverty line, $11,490 for an individual, or $23,550 for a family of four. The poor cannot get subsidized private coverage in the new health insurance markets coming on line next year.
"This decision will have very real human costs for the adults who are going to remain uninsured and their families," said Genevieve Kenney, co-director of the Urban Institute's health policy center. "It seriously undermines the ability of the Affordable Care Act to substantially reduce the number of uninsured in this country, at least at the beginning."
Godzilla, Frankenstein's monster and Bigfoot are mythical creatures that don't exist (although you might dispute the latter). But now, an equally beastly smartphone -- one seemingly designed specifically for them -- is available to buy. The Samsung Galaxy Mega is a 6.3-inch woolly mammoth of a handset, and it reigns as the largest of its kind, even if only for a brief period of time; the title will soon be taken over by the Sony Xperia ZU once it hits the market. We were curious to see how a phone of its size would hold out during regular use, so our friends at Negri Electronics -- an online retailer which currently sells the Mega for $570 or $600 (8GB and 16GB, respectively) -- were kind enough to let us take one for a test drive for a few days. Is the phone's magnitude a benefit or hindrance to the user experience? Is it even worth considering if you don't need the largest possible screen? Find out as we dissect it after the break.
We heard just a few days ago that popular RSS reading app, Reeder for iPhone, was going free while an update for the Google-pocalypse was awaiting approval by Apple. That update has now been approved, and not a moment too soon as Google Reader has now closed its doors for good.
Reeder already offered alternatives to Google Reader, but the big news here is Feedly support. Since Google first announced the closure of Reader, Feedly has lept to the front of the queue of budding replacements. Their user count has increased substantially since then, but their own iOS app doesn't suit everyone.
Feed Wrangler support is also included in this latest version of Reeder, though it's likely the Feedly support a larger number of users were waiting on. It's still showing as free for the time being in the App Store, so grab it quickly, as we pour one out for our dear, old departed friend.
Cadaver study may help clinicians identify patients who can skip ACL reconstructionPublic release date: 2-Jul-2013 [ | E-mail | Share ]
Contact: Phyllis Fisher phyllis.fisher@gmail.com 212-606-1724 Hospital for Special Surgery
A study by researchers at Hospital for Special Surgery has provided the first evidence that the shape of a person's knee could be a factor in the decision of whether a patient should undergo anterior cruciate ligament (ACL) reconstruction after an ACL tear. The study is published online ahead of print in the Proceedings of the Institution of Mechanical Engineering.
"This is the first study to show that after your ACL is ruptured, the changes in the mechanics of the knee can really be affected by the shape of the knee," said Suzanne Maher, Ph.D., associate director of the Department of Biomechanics at Hospital for Special Surgery, New York City. "Previously, researchers had only conducted studies looking at whether a particular knee shape makes a person more likely to have an ACL injury, specifically in the athletic population."
Each year in the United States, 200,000 individuals tear their ACL, including 80,000 athletes. These injuries cost the U.S. health care system $1 billion. An ACL tear puts individuals at a greater risk for developing osteoarthritis, joint degeneration, and loss of the meniscus (cartilage that provides structural stability to the knee when it experiences tension or is twisted). These problems may be prevented by an ACL reconstruction, but not all patients need this surgery. Some individuals have more stable knees and will therefore not develop further problems. If a person is not an athlete playing a sport that involves pivoting, such as soccer or basketball, nonoperative treatment is an option. Identifying patients who can avoid surgery without developing further problems has been tricky.
In the new study, investigators conducted experiments using nine cadaveric knees to examine how knee shape impacts knee mechanics during walking, after a person has torn their ACL. The specimens included the knee joint plus three to four inches of the leg on either side of the knee joint line. The researchers outfitted these knees with a sensor that measured the contact stresses of a critical weight-bearing area on the top of the shinbone called the tibial plateau. They then mounted the knees on a machine that flexed and extended the specimens while applying forces in many directions, all of which together mimics the act of walking. The machine cycles through a step of walking in two seconds.
The researchers analyzed data from 20 cycles in each specimen, both before and after they cut the ACL to mimic a tear. "We thought that if we tested all of these knees, we would see very consistent changes in contact stresses. We would see some areas of the knee that saw a much higher contact stress than they had before we cut the ACL, and we would see other areas that would see a lower load," said Dr. Maher. "What we found instead was that the change in contact stresses were highly variable. The only consistent finding we had was in the back (posterior side) of the knee; all knees had increased contact stress in the posterior central aspect of the knee, at 45% of the gait cycle."
At 45%, a person is in mid to late stance. Dr. Maher explains that at 0% of the gait cycle, a person's heal strikes the ground, and at 14%, the heal and most of the foot is in contact with the ground. A toe comes off the ground and the knee starts swinging at 60% of gait.
While all knees with ACL tears experienced higher stresses in the back part of the tibial plateau, however, some knees also experienced higher stresses in the front of the plateau. "The knees that showed changes in the front of the knee had specific shape features. For example, they had a less concave tibial plateau," said Dr. Maher. "If the tibial plateau has a very deep valley and then you have a femur (thigh bone) sitting in a deep well, that is going to give you a very stable knee. So, when you tear your anterior cruciate ligament, it is not going to have a huge effect." Increased tibial slope was another predictor of increased stress.
The study suggests that clinicians may be able to X-ray knees, evaluate the bony structural geometry, and identify individuals who will have a more diffuse change in contact mechanics after their ACL is torn. In this way, clinicians may be able to determine which patients are more likely to develop further cartilage damage in the front and back of the knee.
"This is a limited study because these are dead knees, we are only looking at walking, it is only a small sample size, we have focused on the inside of the knee, etc., but it provides a glint of information about how the knee functions after an ACL rupture," said Dr. Maher. "Even though this is a lab based study, it suggests that the shape of a person's knee may be ultimately used as some guidance as to whether certain patients should have their ACL replaced or repaired versus other patients."
The fact that all patients had increased stress in one area of the tibial plateau could also help researchers improve ACL reconstructions. "There are very few models that allow you to really understand the forces acting across the knee during walking, let alone how those forces are changing when the ACL is injured," said Dr. Maher. "What this study is telling us is there is a particular part of the gait cycle where your ACL is very active. It is very active in the latter part of stance phase. When designing an ACL replacement, researchers may want to pay close attention as to what it does in the latter part of the stance phase."
###
The work was funded, in part, by money from the National Institutes of Health.
Other Hospital for Special Surgery investigators involved in the study included Russell Warren, M.D., Saadiq El-Amin, M.D., Asheesh Bedi, M.D. (current faculty at University of Michigan Hospitals), Natalie Kelly, B.S., and Tony Chen, Ph.D. Thomas Santner, Ph.D., from The Ohio State University, also contributed to the research.
About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology, No. 10 in neurology and No. 5 in geriatrics by U.S. News & World Report (2012-13), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. HSS is a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www.hss.edu.
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
Cadaver study may help clinicians identify patients who can skip ACL reconstructionPublic release date: 2-Jul-2013 [ | E-mail | Share ]
Contact: Phyllis Fisher phyllis.fisher@gmail.com 212-606-1724 Hospital for Special Surgery
A study by researchers at Hospital for Special Surgery has provided the first evidence that the shape of a person's knee could be a factor in the decision of whether a patient should undergo anterior cruciate ligament (ACL) reconstruction after an ACL tear. The study is published online ahead of print in the Proceedings of the Institution of Mechanical Engineering.
"This is the first study to show that after your ACL is ruptured, the changes in the mechanics of the knee can really be affected by the shape of the knee," said Suzanne Maher, Ph.D., associate director of the Department of Biomechanics at Hospital for Special Surgery, New York City. "Previously, researchers had only conducted studies looking at whether a particular knee shape makes a person more likely to have an ACL injury, specifically in the athletic population."
Each year in the United States, 200,000 individuals tear their ACL, including 80,000 athletes. These injuries cost the U.S. health care system $1 billion. An ACL tear puts individuals at a greater risk for developing osteoarthritis, joint degeneration, and loss of the meniscus (cartilage that provides structural stability to the knee when it experiences tension or is twisted). These problems may be prevented by an ACL reconstruction, but not all patients need this surgery. Some individuals have more stable knees and will therefore not develop further problems. If a person is not an athlete playing a sport that involves pivoting, such as soccer or basketball, nonoperative treatment is an option. Identifying patients who can avoid surgery without developing further problems has been tricky.
In the new study, investigators conducted experiments using nine cadaveric knees to examine how knee shape impacts knee mechanics during walking, after a person has torn their ACL. The specimens included the knee joint plus three to four inches of the leg on either side of the knee joint line. The researchers outfitted these knees with a sensor that measured the contact stresses of a critical weight-bearing area on the top of the shinbone called the tibial plateau. They then mounted the knees on a machine that flexed and extended the specimens while applying forces in many directions, all of which together mimics the act of walking. The machine cycles through a step of walking in two seconds.
The researchers analyzed data from 20 cycles in each specimen, both before and after they cut the ACL to mimic a tear. "We thought that if we tested all of these knees, we would see very consistent changes in contact stresses. We would see some areas of the knee that saw a much higher contact stress than they had before we cut the ACL, and we would see other areas that would see a lower load," said Dr. Maher. "What we found instead was that the change in contact stresses were highly variable. The only consistent finding we had was in the back (posterior side) of the knee; all knees had increased contact stress in the posterior central aspect of the knee, at 45% of the gait cycle."
At 45%, a person is in mid to late stance. Dr. Maher explains that at 0% of the gait cycle, a person's heal strikes the ground, and at 14%, the heal and most of the foot is in contact with the ground. A toe comes off the ground and the knee starts swinging at 60% of gait.
While all knees with ACL tears experienced higher stresses in the back part of the tibial plateau, however, some knees also experienced higher stresses in the front of the plateau. "The knees that showed changes in the front of the knee had specific shape features. For example, they had a less concave tibial plateau," said Dr. Maher. "If the tibial plateau has a very deep valley and then you have a femur (thigh bone) sitting in a deep well, that is going to give you a very stable knee. So, when you tear your anterior cruciate ligament, it is not going to have a huge effect." Increased tibial slope was another predictor of increased stress.
The study suggests that clinicians may be able to X-ray knees, evaluate the bony structural geometry, and identify individuals who will have a more diffuse change in contact mechanics after their ACL is torn. In this way, clinicians may be able to determine which patients are more likely to develop further cartilage damage in the front and back of the knee.
"This is a limited study because these are dead knees, we are only looking at walking, it is only a small sample size, we have focused on the inside of the knee, etc., but it provides a glint of information about how the knee functions after an ACL rupture," said Dr. Maher. "Even though this is a lab based study, it suggests that the shape of a person's knee may be ultimately used as some guidance as to whether certain patients should have their ACL replaced or repaired versus other patients."
The fact that all patients had increased stress in one area of the tibial plateau could also help researchers improve ACL reconstructions. "There are very few models that allow you to really understand the forces acting across the knee during walking, let alone how those forces are changing when the ACL is injured," said Dr. Maher. "What this study is telling us is there is a particular part of the gait cycle where your ACL is very active. It is very active in the latter part of stance phase. When designing an ACL replacement, researchers may want to pay close attention as to what it does in the latter part of the stance phase."
###
The work was funded, in part, by money from the National Institutes of Health.
Other Hospital for Special Surgery investigators involved in the study included Russell Warren, M.D., Saadiq El-Amin, M.D., Asheesh Bedi, M.D. (current faculty at University of Michigan Hospitals), Natalie Kelly, B.S., and Tony Chen, Ph.D. Thomas Santner, Ph.D., from The Ohio State University, also contributed to the research.
About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology, No. 10 in neurology and No. 5 in geriatrics by U.S. News & World Report (2012-13), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center three consecutive times. HSS has one of the lowest infection rates in the country. From 2007 to 2011, HSS has been a recipient of the HealthGrades Joint Replacement Excellence Award. HSS is a member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at http://www.hss.edu.
AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert! system.
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On?any list of writers who should have won the Nobel Prize but didn't, Italo Calvino would have to figure near the top, along with Nabokov and Borges. Calvino, who was born in 1923 and died in 1985, became famous in America mainly as the author of ludid, postmodernist works like?Invisible Cities ? a reworking of Marco Polo's travels, with a buried mathematical structure ? and?If on a winter's night a traveler,?a classic work of metafiction that continually stops and restarts itself while addressing the reader.?
But in his comparatively short life, Calvino played many roles in the literature of Italy and the world. Before he was a postmodernist, associated with the experiments of the Oulipo in Paris, he was a realist whose first successes were Hemingwayesque tales drawn from his own experience as a partisan fighter in Italy during World War II. He was also, starting with his partisan period, a Communist, striving to reconcile his intensely individual genius with the imperatives of the class struggle. When that proved impossible, after the Soviet invasion of Hungary in 1956, Calvino resigned from the Party, but he always considered himself a man of the Left.?
And from the very beginning of his career to the very end, he was also a publisher, associated with the leading Italian house of Einaudi. His work brought him into contact with just about every major Italian writer and cultural figure of the postwar period; many of them were his friends and collaborators, from Cesare Pavese and Carlo Levi to Michelangelo Antonioni and Pierpaolo Pasolini.
This intense activity, this committed and versatile service to letters, is the main impression that the reader takes away from?Italo Calvino: Letters, 1941-1985. A big book at nearly 600 pages, it still represents just a fraction of the correspondence published in Italian, and there are large areas of Calvino's life that go uncovered ? this is not one of those books of letters that can double as a biography.
There are no love letters included, for instance, nor anything to his parents or relatives; indeed, just about anything "personal" is left out. At the same time, Calvino writes in such granular detail about postwar Italian literature, with references to the titles, authors, characters, and plots of hundreds of works, that anyone who is not a specialist in that literature will probably feel a little adrift. (The notes, while numerous, are not nearly full enough for the general reader's purposes ? an adequately annotated edition would probably be twice as long.)?
Yet this austerity feels only appropriate for a man whose ideal way of life, he confides in one letter, would be to spend 12 hours a day reading. Several times in the "Letters," we hear Calvino dissuading people from trying to interview him or write his biography, on the grounds that ? as Barthes was saying around the same time ? the very idea of an "author" was dead, or should be: "To be able to study a writer, he must be?dead,?that is ? if he is alive ? he must be?killed? Furthermore, already the existence of the work is a sign that the author is?dead,?happily dead if the work is worthwhile; the work is the negation of the writer as empirical living being."?
Rather than an individual genius, Calvino wanted to be thought of as a member of a culture and a collective. "Life and works?" he writes to an Englishman proposing to devote a study to him. "I'm afraid I don't think I really have a?life?on which something can be written. All I have is a series of works that form part of the general context of literary works in our time. I am more and more convinced that literature is made up of works, genres, schools, discussions, problems, collective work in order to solve certain problems? If a critic writes about a problem and makes reference to one (or more) of my works in relation to that problem, this gives me the sense that my work is not pointless. Whereas the prospect of my bust crowned with laurel appearing along with the other busts in the hall of famous writers gives me no joy at all."?
LAGOS, Nigeria (AP) ? A woman who could be considered Africa's Oprah Winfrey is launching an entertainment network that will be beamed into nearly every country on the continent with programs showcasing its burgeoning middle class.
Mosunmola "Mo" Abudu wants EbonyLife TV to inspire Africans and the rest of the world, and change how viewers perceive the continent. The network's programming tackles women's daily life subjects ? everything from sex tips to skin bleaching.
"Not every African woman has a pile of wood on her head and a baby strapped to her back!" the glamorous Abudu, 48, told The Associated Press from a hotel's penthouse floor against a backdrop of the Atlantic Ocean and high-rise buildings flanked by palm and almond trees.
"We watch Hollywood as if all of America is Hollywood," she said. "In that same vein we need to start selling the good bits of Africa."
Months of work to provide original content includes the flagship program "Sistaz!" about two Greek-Nigerian sisters and a British-born Nigerian friend who check into the Eko Hotel for a holiday reunion and rediscover the passion of sisterhood and the vibrant city of Lagos.
"It helps show that you can go to Africa for a holiday, you can go to Nigeria on holiday, you can go to Lagos" and enjoy a vacation, Abudu said of the much-maligned Nigerian financial capital that is much improved since the country transitioned from military dictatorship to civilian rule in 1999.
The characters are as cosmopolitan as Abudu, a tall and elegant woman with sculpted cheekbones. She was born in London, came to Nigeria when she was a youngster and returned to Britain after her father died when she was 12. She returned to settle when she married a Nigerian at age 28.
Once her children were in their teens, Abudu, a former executive with the oil giant Exxon-Mobil, abandoned a 20-year career in human resources in 2006 to become a self-taught television talk show host. "Moments with Mo" became the first syndicated daily talk show on African regional TV and also is aired in Britain on a Sky TV channel.
She has interviewed celebrities from Hillary Rodham Clinton, former African presidents F. W. de Klerk of South Africa and John Kufuor of Ghana, former England soccer skipper Rio Ferdinand, musician R. Kelly and American fashion icon Diane Von Furstenberg.
A telling moment for Abudu came she was standing at London's Marble Arch and decided, on a whim, to ask people what came to their minds when they heard the word Africa.
The answers ranged from Robert Mugabe, Zimbabwe's dictatorial ruler of 33 years, the British charity Oxfam and famine to babies with flies on their faces. "The nicest thing I heard was 'sunshine,'" said an appalled Abudu.
Years later, she is setting out to transform that vision by shining a bright light on the so-called "dark continent's" riches ? its super-talented young entrepreneurs, fabulous art scene, up-and-coming fashion designers, provocative authors and sassy musicians.
One program is hosted by rhythm and blues artist Banky W and singer-songwriter Tiwa Savage. Their first program discusses why more and more Nigerian women are bleaching their skins and whether men prefer lighter-skinned black women.
So the network will not ignore some of the darker sides of Africa's realities, though Abudu promises "a different reality."
It will feature a specially commissioned movie, "New Horizons," from award-winning filmmaker Tope Oshin Ogun that bares the plight of women across the continent subjected to domestic abuse, a prevalent crime that is not often addressed.
And radio host Oreka Godis stars in "Love Lounge," where she will ask the cheeky questions for which she is known of sexologists, life coaches and psychotherapists.
While Nollywood movies also are notorious for often poor quality, though this is improving, Abudu aims for the highest quality in a network she hopes will eventually be broadcast beyond Africa to the millions in the diaspora.
"What we say is 'Everything you think you know about Africa is about to change,'" Abudu said.
Outbox, the startup that digitizes?your postal mail then puts it online for access via web, iPhone, Android or iPad, has raised $5 million in Series A funding. The round was led by previous investor Floodgate?and included investment from Founders Fund, Correlation Ventures, TDF Ventures, WTI, Expansion VC, and Peterson Ventures, as well as other angel?investors.
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Public release date: 2-Jul-2013
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