With the Department of Health and Human Services announcing that plans that were supposed to be cancelled this year can now be renewed for another two years, "the health insurance plans participating in Obamacare are a very worried group right now," according to health insurance industry consultant Robert Laszewski. Reported by FOXNews.com 16 hours ago.

Filed under: Family Money, Personal Finance, Layoffs, Emergencies, Financial Education

*Getty Images*

By Holly Perez

It's important to have a stash of cash set aside in an emergency fund. At a minimum, an emergency fund should consist of three months of living expenses. If you have dependents, your emergency fund should consist of six months of living expenses. Here are seven surprises that should motivate you to start or add to an emergency fund:

*Job Loss*

Whether you're laid off or decide to leave a job for personal reasons, an emergency fund provides a temporary income safety net to help pay for necessities.

*Medical Emergencies*

Even if you have health insurance, it doesn't always cover the whole cost of care, especially if you or a family member is in need of an ambulance ride, a major surgery or physical therapy. And don't forget about your pets. Veterinary visits, especially during an emergency, can be costly if you don't have pet insurance.

*Cost of Living Increases*

A fluctuating economy can mean fluctuating bills and housing payments. Whether your rent skyrockets when you renew your lease or your heating bill climbs higher with the cost of energy, an emergency fund will allow you to cover these costs until you find a better financial alternative.

*Transfer or a New Job*

If your company is transferring you to a new office or you just accepted your dream job across the country, your employer will often help pay for your moving expenses -- but not all the time nor always for the full amount. Movers, temporary housing and the cost of furnishing a new place can add up quickly.

*Car Expenses*

If driving is your main mode of transportation, a problem with your car impacts your ability to go to work, shop for groceries and fulfill other activities in your daily routine. Best case, an issue with your car requires replacement of minor parts. At worst, you have to replace it entirely. Either way, car maintenance is expensive and often required suddenly.

*Major Household Repairs*

You may have insurance to cover some of the more common household issues, but if you have a high deductible, it might be a challenge to come up with the cash to repair a flooded basement or repaint the exterior.

*Unexpected Travel*

It may seem ominous to plan ahead for mourning, but if you lose a loved one, the last thing you want to worry about is travel costs. You also wouldn't want the cost of a plane ticket to prevent you from being there when someone you love gives birth, gets married or marks an important event.

If starting an emergency fund feels overwhelming, start small. Setting aside even a few dollars a week will help build up a reserve over time.

Holly Perez is a consumer money expert at Intuit and spokeswoman at mint.com, a Web and mobile money management tool.

--------------------

-*More from U.S. News*-

· 11 Expenses Destroying Your Budget
· 10 Ways to Upgrade Your Finances in 2014
· 4 Ways to Boost Your Emergency Fund

 

Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 17 hours ago.

Today's nonfarm payroll number is set to be a virtual non-event: with consensus expecting an abysmal print, it is almost assured that the real seasonally adjusted number (and keep in mind that the average February seasonal adjustment to the actual number is 1.3 million "jobs" higher) will be a major beat to expectations, which will crash the "harsh weather" narrative but who cares. Alternatively, if the number is truly horrendous, no problem there either: just blame it on the cold February... because after all what are seasonal adjustments for? Either way, whatever the number, the algos will send stocks higher - that much is given in a blow off top bubble market in which any news is an excuse to buy more.

So while everyone is focused on the NFP placeholder, the real key event that nobody is paying attention to took place in China, where overnight China’s Shanghai Chaori Solar defaulted on bond interest payments, failing to repay CNY 89.9mln (USD 14.7mln), as had been reported here extensively previously. This marked the first domestic corporate bond default in the country's history - indicating a further shift toward responsibility and focus on moral hazard in China. Whether or not this is China's "Bear Stearns" moment remains to be seen, however nearly a dozen deals were postponed or canceled in the aftermath of this development meaning that as expected the entire bond market is set for a repricing now that moral hazard may have to be taken out of the equation - the end result will be yields that are hardly lower which for a $12 trillion corporate bond market can only spell bad news. But since the market has long ago lost its discounting capabilities, expect to feel the impact of future bond defaults in real time.

In the meantime, copper (futures down over 2.0% this morning) which is heavily used for debt financing in China specifically, and Shanghai Chaori Solar's failure to repay is being seen as a warning shot that many more could follow, as the Chinese authorities pull away from their previous policy of bailing-out-at-all-costs. As such, copper prices have fallen in tandem with a declining appetite for credit in China.

Stocks in Europe traded lower this morning, with Bunds also better bid as market participants positioned ahead of the release of the latest jobs report by the BLS later on in the session. Despite the absence of apparent appetite for risk, it was the health care related stocks that led the move lower which indicates that the price action  was largely result of investor positioning and not a fundamental shift in the outlook. Still, safe haven related flows supported JPY which in turn weighed on the USD and ensured that EUR/USD and GBP/USD traded in the green.

Going forward, apart from awaiting the release of the latest jobs report by the BLS, market participants will also get to digest the release of the latest jobs report from Canada.

*Bulletin news summary from Bloomberg and RanSquawk*

Treasuries steady, long end leads, before report forecast to show U.S. economy added 149k jobs in February while unemployment rate held at 6.6%.

The U.S. and EU put Russia’s Vladimir Putin on notice that they will be united on imposing sanctions if he’s unwilling to defuse the Ukraine crisis and pursue a negotiated solution

The crisis in Ukraine is putting the question of Poland’s accession to the euro back on the agenda as the military standoff stirs memories of the Cold War

German industrial production rose 0.8% in January, the third consecutive monthly gain and in line with median estimate in Bloomberg survey

EUR/USD rose as much as 0.35% to 1.3909, strongest since October 2011

Shanghai Chaori, a Chinese solar-cell maker failed to pay full interest on its bonds, leading to the country’s first onshore default and signaling the government will back off its practice of bailing out companies with bad debt

California Governor Jerry Brown, who decries a widening gulf between rich and poor, is campaigning for a fourth and final term presiding over a state that’s outpacing the U.S. in producing both millionaires and food-stamp recipients

Gary Cohen, the top U.S. health insurance regulator accused by congressional Republicans of misleading them before the troubled start of the Obamacare website, will resign

Sovereign yields mixed. EU peripheral spreads narrow. Asian equities mixed, Nikkei +0.9%; Shanghai Composite little changed. European equity markets decline, U.S. stock-index futures gain. WTI crude and gold little changed, copper falls

*US event calendar*

· 8:30am: Trade Balance, Jan., est. -$38.5b (prior $38.7b);
· 8:30am: Change in Nonfarm Payrolls, Feb., est. 149k (prior 113k); Change in Private Payrolls, Feb., est. 145k (prior 142k); Change in Manufacturing Payrolls, Feb., est. 5k (prior 21k)

· Unemployment Rate, Feb., est. 6.6% (prior 6.6%)
· Average Hourly Earnings m/m, Feb., est. 0.2% (prior 0.2%)
· Average Hourly Earnings y/y, Feb., est. 2% (prior 1.9%)
· Average Weekly Hours All Employees, Feb., est. 34.4 (prior 34.4)
· Change in Household Employment, Feb. (prior 638k)
· Underemployment Rate, Feb. (prior 12.7%)    --
· Labor Force Participation Rate, Feb. (prior 63%)

· 3:00pm: Consumer Credit, Jan., est. $14b (prior $18.756b) Central Banks
· 12:00pm: Fed’s Dudley speaks in New York
· 12:30pm: Former Fed Chairman Bernanke speaks in Houston

*Asian Headlines*

Shanghai Chaori Solar defaulted on bond interest payments, failing to repay CNY 89.9mln (USD 14.7mln), alongside expectations. (WSJ) Despite the small size of the default, this marks the first domestic corporate bond default in the country's history - indicating a further shift toward responsibility and focus on moral hazard in China.

*EU & UK Headlines*

Analysts at BNP Paribas revise their ECB QE forecast and now see QE in Q4 vs. Prev. view that the ECB would engage in asset purchases after ECB staff projections in June.

Fitch affirms ESM at AAA; outlook stable. (DJN)

UK BoE/GfK Inflation Next 12 Mths (Feb) 2.8% (Prev. 3.6%). 40% of Britons expect rate increase in the next year vs. 34% in November, rate-increase expectation at highest since May 2012. (BBG/RTRS)

According to official models from the Office of Budget Responsibility, the UK faces a GBP 20bln black hole in public finances, suggesting further austerity and throwing doubt on whether the recovery will eliminate the deficit. (FT)

*US Headlines*

Fed's Lockhart (non-voter, dove) said is prepared to consider overshooting on inflation, up 2.5%, to aid job gains. (RTRS)

Lockhart also commented that passing the 6.5% jobless rate should be a trigger to update forward guidance on forward rates and that bad weather may have cut GDP by 0.75 percentage points. (BBG)

*Equities*

While all ten sectors traded in the red this morning, the underperformance was led by health care and basic materials sectors, with the latter driven by concerns over potential implications that the first corporate bond default in China will have on the use of metal to finance debt. This also saw copper futures fall over 1.5%, with other precious and base metals also trading lower.

*FX*

With little in the way of major macroeconomic releases during the first half of the session this morning meant that the price action was largely driven by positioning ahead of the upcoming release of the latest jobs report by the BLS. As a result, risk off related flows weighed on USD/JPY and weighed on the USD. Consequently, despite cautious comments by RBA governor Stevens who stated that AUD/USD over 0.90 is higher than the RBA's assessment, together with lower gold prices, meant that AUD/USD remained bid.

*Commodities*

Copper (futures down over 2.0% this morning) is heavily used for debt financing in China specifically, and Shanghai Chaori Solar's failure to repay is being seen as a warning shot that many more could follow, as the Chinese authorities pull away from their previous policy of bailing-out-at-all-costs. As such, copper prices have fallen in tandem with a declining appetite for credit in China.

US House Speaker John Boehner said the US should open gas exports in order to counter the actions of Russian President Putin. (WSJ) Boehner believes a lifting of the de-facto ban on exporting US produced LNG would lessen dependence on Russian gas exports across west and eastern Europe.

CME lowered natural gas Henry Hub futures for specs by 18.5% to USD 4,400 per contract from USD 5,225. (RTRS) Russian NatGas and crude oil transit flows via Ukraine are uninterrupted and at normal levels, according to Gazprom. (BBG)

BP is seen to be skirting the US oil export ban, by taking on at least 80% of the capacity in the new USD 360mln Splitter mini-refinery that will produce just enough to escape restrictions on sales outside the US. (BBG) Meanwhile, the Co. has warned that fines over the Gulf of Mexico oil disaster in 2010 could exceed the USD 18bln it is braced for. (Telegraph)

ANZ said that gold consumption growth in China is slowing and that Indian gold demand remains robust. ANZ also raised its gold forecast for 2014 by 5.5% to USD 1339/oz and raised its spot silver forecast by 8.3% to USD 22.20/ oz, but added that gold may drop below USD 1300/oz in the near-term as China demand wanes. ANZ has also stated that platinum 'has room' to rally against gold. (BBG)

* * *

*We conclude with the overnight summary from DB's Jim Reid*

It’s fascinating that in this period where the S&P 500 is 277% higher, nominal and real GDP are only 11% and 19% higher respectively and the average monthly payroll has only been 72k. It clearly shows how important the Fed (and other central banks) have been. We still think markets will be a lot more challenging once the Fed’s balance sheet starts to level off but for now it’s still increasing at $65bn/month. Talking of payrolls it’s that time of month again. After two disappointing numbers for December (+75k) and January (+113k) and disappointing readings from Wednesday’s ADP (+139k vs +155k expected) and the ISM non-manufacturing employment component (47.5 vs 56.4 last month) the market consensus is for a February figure of +149k whilst DB is forecasting +120k. The consensus may actually be lower than this but maybe not everyone has updated their forecasts after this week’s data. Consensus is expecting the unemployment rate to hold steady at 6.6% whilst
DB’s US Economists expect it to fall -0.1% to 6.5% although they note a larger decline is possible due to the expiration of extended unemployment benefits last December. Whilst the consensus NFP number would mark an improvement on January, a +149k reading would represent a sharp discount from the +204k averaged through the first eleven months of 2013 so it easy to see how bad weather is playing a role here even if the size of the impact is difficult to calculate. As DB’s Joe LaVorgna notes, if weather really is weighing on the numbers then we would expect to see a jump in the number of people who have a job but did not report to work because of “bad weather” which is data the BLS provides within the Household Survey. Even accounting for the past few month’s numbers, DB continues to expect average monthly payroll gains of around +240k in 2014. This would be some pick-up on the post crisis average of 72k discussed above.

Moving back to the other big event of the week, the ECB yesterday kind of told us that they are only going to act when absolutely necessary as they yet again missed an opportunity to be proactive in the fight against future possible low inflation/deflation. It now seems last November’s pre-emptive rate cut was an anomaly and not part of a new policy trend for the ECB. Overall our economists thought it would be difficult for the ECB to publish an inflation forecast materially below its own definition of price stability without providing more accommodation. However, this is indeed what they chose to do. They now think the ECB seems to be “hoping for the best”, and in their call for a cut yesterday they acknowledged they may have underestimated the Governing Council’s lack of room for manoeuvre. They now expect policy rates to be unchanged throughout 2014 given this. Given the above it wasn’t a surprise to see the Euro trade at the highest point since October 2011. Indeed will their lack of action be the spur for a sustained strong currency which continues to put downward pressure on inflation and forces them to act later in the year? Our bias remains that it will but yesterday proved that the ECB will need hard facts for them to be able to act.

After a mid-week lull, Ukrainian and Russian headlines increased yesterday, but for now global markets have been able to weather the newsflow. That isn’t to say that there haven’t been pockets of volatility as Russian equities (MICEX - 0.97%) and Russian fixed income (10 year +13bp) had a week day. On Thursday, Crimea’s parliament decided overwhelmingly to “enter into the Russian Federation with the rights of a subject of the Russian Federation” in a non-binding parliamentary vote. The parliament also set a referendum for March 16th for Crimean voters to decide if they wanted the peninsula to join Russia. If the move is approved by the referendum, all state property would be “nationalised”, the Ruble adopted and Ukrainian troops would be treated as occupiers and forced to surrender or leave, according to the Vice Premier of Crimea. Obama described the proposed referendum as a violation of the Ukrainian constitution and a violation of international law and announced potential sanctions against Russian officials who are involved in military action in Ukraine. The EU also looks set to follow with targeted sanctions. So the crisis doesn’t look like it’s over even if markets have become a bit more sanguine about the endgame.

Looking at overnight markets, Asian equities are trading with modest gains led once again by the Nikkei (+0.8%), mirroring a similar gain for the S&P 500 on Thursday (+0.17%). Onshore Chinese equities are once again lagging today possibly due to the news of China’s first corporate bond default (more below). In Asian currencies, the Indian Rupee (+0.15%) is adding onto yesterday’s 1.04% gain, further cementing its spot as one of the best performing currencies of late in Asia and the EM world. In China, domestic Chinese interbank rates continue to range around multi-month lows and both CNY (+0.05%) and CNH (+0.05%) are on track for one of their strongest weeks in two years.

On the topic of China, according to the WSJ the country’s first onshore corporate bond default has occurred earlier today in the form of Shanghai Chaori Solar Energy’s missed/incomplete RMB89.8m coupon payment. As we have written over the last couple of days, the bond is relatively small (RMB1bn or US$160m in face value) and the issuer is small (US$1.2bn in assets) but it’s an interesting case for a number of reasons. Firstly, it’s a bond where the majority of bondholders are retail investors (WSJ, citing company management) which widens the scope of the impact from the market’s typical institutional investor base. Weibo, China’s version of Twitter, is showing photos of retail investors at a local Shanghai government office protesting the authorities’ lack of action in assisting the issuer (21st Century Business Herald). Secondly, it should be highlighted that Shanghai Chaori avoided a default on its annual coupon payment last year due to the intervention of a local Shanghai government who persuaded banks to roll over loans. This time around, the policy appears to have changed with no last-minute assistance on the cards. Indeed, state-affiliated news agency Xinhua wrote in an opinion piece that a default would be the “the market playing its own decisive role”. Interesting, given that the Chinese solar energy market was heavily subsidised by the Chinese government in recent years. The Xinhua article also commented that Chaori was not going to be China’s “Bear Sterns moment”. In addition, domestic media are reporting that the company’s bankers and bond underwriters will not be helping the company make interest payments (21st Century Business Herald). Though this is a relatively small bond, there are potentially wider ramifications. Bloomberg reports that China’s  renewable energy industry faces US$7.7bn in bond maturities this year, and already three domestic bond issuances have been postponed or cancelled in recent days
according to Reuters. This is certainly a macro story to watch in 2014.

Looking at the day ahead, the main focus will be on US payrolls due out at 1:30pm London time which will dictate the tone for the rest of the day. US trade numbers for January will also be released at the same time as payrolls and US consumer credit numbers will be published towards the end of the US session. Ahead of payrolls, Europe will be focused on French trade (January) and German industrial production. Over the weekend, China will publish its February inflation and trade reports. The trade report will be closely watched in light of January’s Chinese exports which were significantly above consensus possibly due to Lunar New Year effects or potential invoicing distortions. For the record, consensus is expecting February export and import growth of 7.5% and 7.6% YoY respectively. Reported by Zero Hedge 17 hours ago.

One of the nation’s largest clinical research programs has chosen to use SIGNiX’s electronic signature service to speed up the consent process for clinical trials.

Chattanooga, Tenn. (PRWEB) March 07, 2014

SIGNiX, the most trusted name in digital signatures, today announced that one of the nation’s largest clinical research institutes selected SIGNiX to accelerate and simplify its consent process. SIGNiX’s technology will enable patients and clinical investigators to sign consent forms online from any computer or mobile device.

“It’s not just about efficiency for this research institute. It’s about helping a grandfather with heart disease who’s afraid he’s going to have a heart attack. It’s about helping a single mother suffering from breast cancer who needs a better treatment plan,” said Gary Peat, Senior Vice President of Corporate & Business Development at SIGNiX. “The faster they can get their consent forms signed, the faster they can complete clinical trials and get real solutions to the people who need them most.”

Not only will SIGNiX’s digital signature technology be more convenient for patients, but SIGNiX will also save staff members significant time because documents get sent for signature instantly along with automated reminders that speed the process.

The research institute expects to save more than $1 million each year by switching to a digital consent process. Before choosing SIGNiX, the institute was shipping at least 40,000 documents each year using next-day mail. With SIGNiX, they will not only save on shipping, printing, faxing and filing paper documents but will also be able to re-allocate staff to more productive activities.

SIGNiX’s digital signature technology will also enhance compliance for the research institute. By enabling required fields, the institute can be sure that each document is filled out completely, eliminating errors and repeated processes.

“Missing signatures on consent forms can put the institute’s entire drug trial at risk,” said Jay Jumper, president and CEO of SIGNiX. “With SIGNiX, we can be sure that every document is legally signed and compliant.”

Other important factors that led the research institute to choose SIGNiX included:· Standards-based digital signatures
· Embedded signature verification
· Flexible signer authentication options
· Reliable and consistent performance
· Compliance with regulations set by the Health Insurance Portability and Accountability Act (HIPAA) and by the FDA’s 21 CFR Part 11

The research institute is part of one of the nation’s leading healthcare companies.

About SIGNiX
SIGNiX, the Global Digital Signature AuthorityTM, makes signing documents online safe and secure. SIGNiX offers the only independently verifiable cloud-based digital signature solution, which combines convenience with best-in-class security. SIGNiX’s products help the world’s leading companies become more efficient, decrease risk and boost profits. For more information, visit http://www.signix.com or follow SIGNiX on Twitter. Reported by PRWeb 16 hours ago.

The new health insurance marketplaces appear to be making little headway in signing up Americans who lack insurance, the Affordable Care Act's central goal. Reported by TwinCities.com 15 hours ago.

A specialist in a range of insurance types, Hockley & O’Donnell Insurance Agency, LLC is now offering a time saving online insurance quotes facility.

Gettysburg, PA (PRWEB) March 07, 2014

Hockley & O’Donnell Insurance Agency, LLC, a specialist in a range of different types of insurance coverage, is now offering website visitors the opportunity to save time by providing an online quote facility for all of the different types of coverage it deals with. The company deals with various popular forms of insurance, including auto insurance cover, business and commercial insurance coverage, home insurance, and life/health insurance.

By using the quotes facility in order to get the best price on coverage, consumers using the website will now be able to save themselves a considerable amount of money on the cost of their coverage. The feature is designed to make it easier for consumers to get the best deals on the cost of their insurance and to enable them to find the most appropriate cover for their needs more quickly.

In order to get quotes on insurance deals, users simply have to click on the type of insurance coverage they are interested in taking out. This will then enable them to key in some details so that deals can be compared ready for them to browse. If the consumer is happy with both the quote and the details of the policy, coverage can be quickly and conveniently arranged.

An official from the company said: “The convenient insurance quotes facility that we have put into place will make it far easier for our website visitors to find the most suitable coverage for their needs at the right price. We offer access to a huge variety of competitively priced insurance plans, which will boost the chances of our customers being able to find the right protection at the right price. We also offer a choice of different types of insurance coverage, which include home, health, auto, and life insurance as well as business coverage.”

To find out more, please visit http://www.hockleyandodonnell.com/.

About Hockley & O’Donnell Insurance Agency, LLC

Hockley & O’Donnell Insurance Agency, LLC is a specialist in the insurance industry, offering access to a range of insurance deals.

Contact information

Hockley & O’Donnell Insurance Agency, LLC

132 Buford Ave
Gettysburg, PA 17325
United States
Phone Number: (717) 334-6741 Reported by PRWeb 15 hours ago.

Now offering businesses the ability to participate in one of the fastest growing trends in group health insurance.Nevada Insurance Enrollment Marketplace today announced the growing popularity of "Private Exchange" technology for businesses that provide employers and employees the ability to participate in one of the fastest growing trends in health insurance - "Defined Contribution" Health Plans. If you'll recall the Pension-to-401k transition many years ago, this growing trend of replacing Group Insurance with Defined Contribution will build, as group health insurance plans become less and less viable due to cost and regulations that restrict family members of employees the ability to get their health insurance "Subsidized".

According to Shelly Rogers of Nevada Insurance Enrollment Marketplace, a defined contribution health plan is an important alternative to traditional group health insurance plans for those employers who can no longer afford them, and they are growing rapidly in popularity. Rather than paying a portion, or all of the premium, under a defined contribution health insurance plan, an employer can offer a fixed dollar amount each month for employees to use to pay for their choice of individual health insurance. This allows the employer to feel great about contributing towards the employee's health insurance choices, and frees up the employer to spend more time on their own business.

Employees participating in a defined contribution program through an employer are directed to the health insurance agent's private exchange website or the option is available to have an employers private exchange website, where the employees can compare and select a policy from among a variety of individual health insurance plans being offered by health insurers in their area, including the Government Subsidized health plans "On Exchange." The private exchange is a tool that provides employees with more choice, and makes it possible for agents to more effectively provide services to large numbers of individuals and their families rather than employer groups. Employees can be connected directly to live licensed experts, who can provide them the best options for their family, regardless of pre-existing conditions or budget.

The Private Exchange is not limited to just health insurance solutions, although that is the greatest concern for most employers and employees. We have experts available in life insurance, long term care insurance, Medicare supplements, Dental and Vision, voluntary benefits (accident, critical illness, hospital indemnity), and even property and casualty insurance.

Forward thinking employers have already begun adopting the Nevada Insurance Enrollment Marketplace solution to their benefit challenges. Early adopters to this model are already finding it to be the perfect solution, especially if they had given up on offering their employees any type of benefits. Now you can offer access to individually owned, selected benefits, at little cost to you the employer. More information about defined contribution plans and Nevada Insurance Enrollment Marketplace services can be found on their website at http://nevadainsuranceenrollment.com/private-health-insurance-exchange-for-business/

Company Contact Information
Nevada Insurance Enrollment Marketplace
Shelly Rogers
7065 W. Ann Road
#130-619
89130
702-898-0554

News and Press Release Distribution From I-Newswire.com Reported by i-Newswire.com 15 hours ago.

On Friday, the Labor Department reported the economy gained 175,000 jobs in February, roughly on pace with population growth. In a worrying trend, though, the Department also reported that the average number of hours worked fell for the month. Production and non-supervisory employees averaged just 33.3 hours a week in February. That is down 1.5% since last year.   

Average weekly hours worked are a leading indicator of future job growth. Employers will generally add hours to existing employees before making new hires. Falling hours, however, indicate there is room in the existing labor force to meet current demand. Off all industry sectors, only mining and information saw an increase in average hours worked from last year. Seventeen industry sectors saw average weekly hours fall. Hours worked for all employees similarly fell.

Both retail trade and leisure & hospitality, which together employ almost 30 million Americans, both saw average hours worked fall below 30 hours a week. Last year, retail trade hours were just over 30 hours a week. Last month, weekly hours in the sector average just 29 hours. In leisure & hospitality, average weekly hours worked were under 25 hours. 

In early February, the CBO estimated that the impact of ObamaCare's health insurance mandate would lead to a decline in average hours worked over the next decade. The agency estimated that average hours worked would fall by 1.5-2% by 2024. That's already happened this year. The CBO's estimate of the equivalent of 2 million full-time jobs disappearing may be a best case scenario. 

 
 
 
  Reported by Breitbart 13 hours ago.

The Affordable Care Act creates a new health insurance marketplace (the exchange). But because of the great uncertainty about what buyers will enter the market and who will buy what product, the law creates three vehicles to reduce insurance company risk. John Goodman explains why this is such a dangerous proposition... Reported by The Daily Reckoning 12 hours ago.

Add-on to make comparing plans on health insurance exchanges easier being tested in Illinois Reported by ABCNews.com 11 hours ago.

As more abortion clinics close in the state of Texas, a retrospective look at the politics that led to this form of oppression points mostly at men. In fact, the five Republican candidates for the most powerful statewide offices in Texas, all of whom are dedicated to increasing abortion restrictions, are male. Glenn Hegar, a state senator who leads going into a runoff for the Texas comptroller nomination, was the author of the law that is closing clinics and putting the lives of countless women at risk because the new regulations create an inability for service providers to deal safely with problem pregnancies.

Hegar's bill was co-sponsored in the house, however, by a woman, St. Rep. Jodie Laubenberg, but her intellectual contributions have to be considered minimal. She famously explained on the house floor that hospitals use rape kits to "clean out" victims so they do not get pregnant. Laubenberg has not, in any case, been committed to women's health in Texas, the insidious guise under which abortion laws are politically marketed. She had previously written an amendment to an appropriations bill that restricted low-income women from getting prenatal care during the first three months of pregnancy if they were on the federally subsidized low-income Children's Health Insurance Program. When she was confronted about the measure, Laubenberg said, "But they aren't born yet."

Her demonstrable obliviousness made her a perfect associate for Hegar's plan.

Hegar's first run at statewide office is for comptroller, a position that has nothing to do with abortion rights. Regardless, his campaign, which has taken him to the brink of winning the GOP nomination without a runoff, concentrated on conservative issues like abortion restrictions and gun rights as qualifications to manage tax dollars. Hegar's tenure in the state senate, meanwhile, has exhibited what almost amounts to obsession with abortion. He is co-author of the law requiring sonograms, and the pre-born pain bill, which claims, without scientific evidence, that fetuses at early gestation feel pain during abortion. He also worked with anti-choice organizations to require doctors to have admitting privileges at surgical centers before being allowed to perform abortions, and he authored the ban on abortions after 20 weeks.
Texas St. Sen. Glenn Hegar - How Do You Like Me Now?

Although Gov. Rick Perry's name is on the law, Hegar's anti-abortion zeal is what led to the restrictions that most recently prompted the closing of the Women's Whole Health clinics in the Rio Grande Valley and Beaumont, and will eventually leave the state with about a half-dozen facilities that are legal. Hegar has been running for the financial office of comptroller, oddly, on a platform of gun rights and abortion restrictions, and admitted during the videotaping of a Tea Party speech that he was not really properly experienced for the job he was seeking.

"The question that he'd asked, he said, 'So serving in the legislature qualifies you to be the next Texas Comptroller,' and if it wasn't for the camera, I would have laughed because I do not think serving in the legislature in any shape, form, or fashion qualifies a person in and of itself to be comptroller."

Nor does passing laws to end abortion rights.

Hegar may be less worrisome to Texas women if he gets elected comptroller but the GOP candidate leading the runoff for Lt. Governor is considerably more problematic. Dan Patrick, a former TV sportscaster who was most famous for wearing blue foam hats on the air before he ran for public office, is determined to eliminate any type of abortion in Texas. A state senator who now appears poised to defeat the incumbent Lt. Governor David Dewhurst, Patrick will not rest until he has figured out a way to close every abortion clinic in Texas and probably turn them into churches to worship his god. Unfortunately, if elected, he will have the greatest constitutional authority offered by Texas government.

But Patrick already wants more power.

The Texas senate has operated for decades using a two-thirds rule, which requires that 21 members of the 31-seat body agree before any issue can be brought to the floor for debate. The measure has long prevented public acrimony over controversial laws and has enabled the minority Democrats to have a modicum of influence. Patrick has described the two-thirds rule as a tool for enabling the "tyranny of the minority," which is, obviously, anyone who opposes his political perspective. If Patrick achieves a change in the tradition of a two-thirds vote, there is little doubt Texans will see an ensuing tsunami of legislation to prevent abortion. The current Lt. Governor David Dewhurst has indicated he is also going to "lead the charge to get rid of that rule," and his political platform on abortion is as rigorously anti-woman as Patrick's. He has repeatedly crowed about how proud he is to have defunded Planned Parenthood in Texas.
Texas St. Sen. Dan Patrick

The governor, who would sign these bills, if St. Sen. Wendy Davis does not win election in the fall, is Greg Abbott, the Texas attorney general. Abbott's position on abortion is as extreme as Gov. Rick Perry's and does not allow for exceptions in the case of rape, incest, or danger to the life of the mother. He argues for something he refers to as a "whole life process," which supports the mother and the child through the difficult pregnancy. Unfortunately, he has been supportive of the budget cuts and stringent policies in Texas that make it difficult for women to get health care or any other kind of family planning or assistance services, and any woman with financial issues and a problem pregnancy is going to end up with almost no "life process" support in Texas.

The reasons are a consequence of Abbott and Perry's politics. Texas ranks 45th out of all states for the percentage of women getting prenatal health care and 44th for the percentage of citizens receiving Medicaid. Abbott, Perry, Patrick, and Dewhurst have vigorously opposed expanding the coverage of Medicaid under the Affordable Care Act, which would have provided health insurance for up to 1.7 million Texans, an almost sinful political posture in a state that ranks 2nd in the number of teenaged girls having babies.

While Abbott, Perry, Dewhurst, Patrick, and Hegar claim to care about the unborn and protecting life, the policies they have promulgated evidence no such sensitivities. An annual study by a Texas House caucus, called Texas on the Brink, reports nine percent of all Texas children live in extreme poverty where the household income is below 50 percent of the national poverty level. The state has the second highest percentage of a population that goes hungry on a daily basis. A million children in the Texas are without health insurance of any kind. A woman forced into having a child without the resources to support it would discover that the Maximum Temporary Assistance for Needy Families in Texas for a family of three is a one time cash payment of $201.79.

Protect the unborn. Turn your backs on the born.

Abbott, Perry, Patrick, Dewhurst, and Hegar claim to sanctify the unborn but they are not very interested in helping the child outside of the womb, nor have they created a state economy or culture that provides opportunities to overcome disadvantages inherited at birth, which often come with teenaged or problem pregnancies. And yet they keep acquiring more political power from the electorate and advancing increasingly extremist policies. These men of wealth, who live almost without risk, deserve blame for the physical harm many women are enduring under their abortion regulations.

But the fault, and the guilt, for this mess belongs to Texas voters.

Also at: Don't Grow Texas Reported by Huffington Post 10 hours ago.

The Department of Health and Human Services extended its contract with Verizon Communications Inc.'s Terremark subsidiary as the web-hosting provider for the federal health-insurance marketplace HealthCare.gov. Reported by Wall Street Journal 10 hours ago.

With Missouri apparently lagging behind in health insurance sign-ups, advocates are launching a concerted push this weekend to enroll people through a federally run insurance website before an impending deadline. Reported by Miami Herald 10 hours ago.

LOUISVILLE, Ky., March 7, 2014 /PRNewswire-USNewswire/ -- The chief executive officer of Kentucky's all-new, nonprofit health insurance carrier, Kentucky Health Cooperative, Inc., Janie Miller, has been elected vice chair of the board of directors of the National Alliance of State Health... Reported by PR Newswire 10 hours ago.

Filed under: Retirement, Health Insurance, Retirement Living, Social Security, Ripoffs & Scams

*Getty Images*

By Dave Bernard

Eventually, everyone would like to find themselves at a point when they can safely and securely move into retirement. Whether or not they actually make the move, having the option to retire can offer genuine peace of mind. But that peace of mind may be short lived if the new retiree begins their second act with an unrealistic sense of security. Retirement has the potential to be a fulfilling and exciting adventure, but you need to be careful to avoid those gotchas along the way:

*Underestimating how long you will live.* Your Social Security monthly payments depend on when you began receiving benefits. If you live until the average life expectancy you will receive about the same amount of lifetime Social Security benefits no matter what age you first sign up, according to the Social Security Administration. But if you live beyond the average life expectancy the monthly amount you receive can become increasingly important. For each year beyond your full retirement age you delay receiving benefits your check will grow 8 percent up to age 70. For people who live a long time, that additional amount can make a huge difference in the lifestyle they can afford to live. It makes sense to consider the possibility you may live well into old age and adjust your Social Security claiming strategy accordingly.

*Not paying enough attention to the little things.* As we age we increasingly depend on assistance from others. Our initial struggle to maintain our independence needs to evolve into acceptance of the realities of aging.
Careful attention to details can make all the difference. It is important to take the right medications at the right time every day and schedule and maintain regular appointments for physicals, eye checkups and dental care. Also, pay attention to your surroundings and make adjustments to support a safer existence. Updating your home to fit your needs as you age could help keep you safe and independent for as long as possible.

*Withdrawing from the world.* For some seniors, challenges that come with aging can seem like too much to handle. Physical and mental changes often make it easier to just stay home and avoid exposure to an increasingly difficult world. But such a course of action can lead to loneliness and actually intensify the challenges they wish to avoid. By avoiding contact and the stimulation that comes from interacting with others, our reflexes and mental acuity can dull. The television is a sad replacement for real dialog with friends and family. And sitting all the time will be bad for your physical health as well. It may not always be easy, but making the effort to get out and about can help your health and attitude in many positive ways.

*Becoming a victim.* Scammers and criminals of all sorts see the growing senior population as a group ripe for the picking. Elaborate scams appeal to the caring nature of the elderly with no concern for the damaged lives left in their wake. My mom recently received a call from someone claiming to be her grandson stuck in Mexico with a friend, turning to grandma to save the day. My mom was not fooled, and when she offered to have the scammer talk with her husband they hung up. These days it helps to be suspicious. Don't allow yourself to become an easy victim.

*Believing you are too old to enjoy life.* Obviously what you are capable of doing at 70 is different than what you did at 30. But just because you can't do everything you used to doesn't mean you are too old to realize a meaningful and exciting existence. When you feel too old, take a moment and consider those who have gone before you. Frank Lloyd Wright completed his design of the Guggenheim Museum at age 91, and Michelangelo was hard at work on St. Peter's Basilica in the Vatican at 88. Sure the years add up, but when are you really too old to enjoy life? Don't give up on the retirement life you want.

Dave Bernard is the author of "I Want To Retire! Essential Considerations for the Retiree to Be." Although not yet retired, he focuses on identifying and understanding the essential components of a fulfilling and meaningful retirement. He shares his discoveries and insights on his blog Retirement-Only The Beginning.

--------------------

-*More from U.S. News*-

· The 10 Best Places to Retire on $75 a Day
· The Best Places to Work in Retirement
· 5 Retirement Penalties to Avoid

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Permalink | Email this | Linking Blogs | Comments Reported by DailyFinance 10 hours ago.

For the third week in a row, state health officials said they have yet to figure out how to fix the Health Connector website. Instead, they focused on efforts to keep people covered by health insurance by using paper applications and other workarounds. Sarah Iselin, the special assistant to Gov. Deval Patrick tasked with cleaning up the website mess, said the backlog of paper applications now stands at 43,000, down from 54,000 a week ago. The team of state workers and vendor staff entered data from… Reported by bizjournals 9 hours ago.

Silence equals death.

California AIDS activists taught the world the power of plain and direct talk about gender bias and sexuality to save lives.

The ability to control whether and when to have a child are key to the physical, social and economic health of women and families, and access to legal, safe and affordable birth control and abortion are essential to guarantee that ability.

Currently, a barrage of extreme and punitive laws restricting these rights are streaming out of state legislatures and the House of Representatives. These shockingly offensive departures from the American mainstream demand bolder leadership by our elected officials, and concerted organizing by pro-rights advocates that engages and mobilizes the majority of the American public who are appalled by these assaults but will otherwise remain stunned into silence. Polling and politics as usual are not turning the tide.

Draconian restrictions on facilities that provide abortions in Texas have reduced their number from 44 in 2011 to 24 today. The number is expected to drop to 6 by September. Reports are already surfacing from Texas of women returning to desperate -- and deadly -- measures of self-abortions, like coat hangers and bleach.

Part of the problem is that the health consequences of the attacks are graphically real but have been surgically isolated to the most vulnerable in our society, by income, race and education. Unintended pregnancies and unplanned births are 5 to 6 times higher among women with incomes under 200 percent of the federal poverty level, and also higher for women of color and those without a high school degree.
The odious Hyde Amendment, a congressional measure, prohibits federal funding for abortions. 35 states choose not to supplement Medicaid with state funds for abortions.But its insidious effects extend to California. Although we use public funds to pay for abortions, and a range of family planning services, California's rate of unintended pregnancy is among the highest in the nation, on par with Mississippi and New York.

We must fund abortions. But we can't just can't just slip the money under the table. We need to inform and empower women and men to claim our rights to determine our futures. That includes understanding both our biology and the language we need to stick up for ourselves. The reality is that gender bias has repercussions for all of us, and that procreation involves both sexes.

In case we needed further motivation, opponents are now using the club of funding sources to threaten coverage for everyone. This year the House passed HR 7, that would prohibit private health insurance plans that get a drop of federal funds from covering abortions; this includes virtually all employers who get a tax break if they contribute to the cost of employees' health insurance.

In California two Jesuit universities unilaterally cancelled coverage for abortions in 2013 for their faculty.

The Supreme Court will hear cases on March 25 that could authorize your boss to cut off covering your birth control.

Some are genuflecting to the strategic wisdom of keeping a low public profile on the subject. They claim they can't campaign on abortion and birth control in 2014 because it's an election year. But 2015 will be the run-up to the presidential election. And then 2016 -- well, you know.

In other words: Chances are 100 percent that if political leaders refrain from taking action on this issue in 2014, we are doomed to live in the present for the foreseeable future.
The fact is, voters have demonstrated solid support at the state and local levels for access to legal, affordable reproductive health care services:

Florida voters defeated a state ballot initiative to prohibit public funding for abortions.Mississippi voters defeated a statewide initiative to declare a fertilized egg a person, with 80 percent of black make voters leading the opposition vote.Voters in Albuquerque defeated a proposal to outlaw most late-term abortions.Otherwise vulnerable Democrats won in 2012 against challengers who revealed their Mad Hatter theories about rape and incest.Virginia voters chose a machine Democrat as governor, defeating state attorney general Ken Cuccinelli, an originator of rules forcing women to get -- and pay for -- invasive ultrasounds before proceeding with an abortion they've already decided to have.We have the chance to do a solid: unite all of us to defend both the funding for reproductive health care, and the rights of all of us to enjoy it if we choose.

We can also prevent poor women from being forced by politicians who hate them to bear children they decide they don't want and can't afford, and then subjected to the further indignity of suffering cuts in their food stamps. Or worse, to die from self-induced abortions.Leaders. muster up your moxie and campaign on women's rights and human rights. Opposing the Hyde Amendment would be a good start. We'll support you. Chances are good, we'll all win. Reported by Huffington Post 8 hours ago.

*Treating high cholesterol with statins*

Statin medications lower cholesterol levels in your blood. This can reduce the chance of a heart attack, stroke, and premature death in people who have an elevated risk of developing heart disease or who already have it.

Statins work by blocking a liver enzyme needed to make cholesterol. The body needs some cholesterol to maintain good health. High blood levels of LDL cholesterol and low levels of HDL cholesterol are associated with an increased risk of arterial blockage throughout the body, which could eventually lead to heart attack, stroke, and peripheral artery disease in the legs. Statins may also moderately reduce triglyceride levels, decrease inflammation in arteries, and help raise HDL levels.

There are seven statin drugs, but they’re not all the same. Some statins are backed by stronger evidence than others that they lower cholesterol or reduce the risk of a heart attack or premature death from heart disease or a stroke.

Our recommendations about who should consider a statin drug to lower their cardiovascular risks are based in part on new guidelines from the American College of Cardiology and the American Heart Association. Previous strategies focused mainly on reducing elevated LDL or “bad” cholesterol to very low levels. But the new guidelines consider your overall risk of a heart attack or stroke in the next 10 years more important than LDL cholesterol levels alone. The guidelines determine your risk based on additional factors, including your age, blood pressure level, whether you smoke, are overweight, or have diabetes or other medical problems.

Diet and lifestyle changes, such as quitting smoking, losing weight if you need to, and exercise, can help lower your risk of heart attack and stroke. And in some cases, doing these can reduce your risk enough so that you don’t need a statin. Regardless of whether you take a statin or not, you should still follow them.

Statins can vary widely in cost—from as little as $53 per month to more than $600. Most people who take a statin must continue to do so for years—perhaps for the rest of their life—so the cost can be an important factor to consider.

Certain generic statins can cost as little as $4 for a month’s supply through discount generic programs run by major chain stores, such as Kroger, Sam’s Club, Target, and Walmart. For an even better bargain, you can buy a three-month supply for $10 through these programs. See the price chart below for the generic statins that are likely to be available through these programs.

-The new guidelines recommend the following people consider a moderate-intensity statin (reduces LDL cholesterol by 30 percent to 50 percent)-

• People 40 to 75 years old with an LDL level below 190 mg/dL but who have a high risk of heart attack or stroke of 7.5 percent or greater over the next 10 years.

*Note: *Our medical advisers say that if you fall into this category, you should consider a statin, but for some people, especially those with a 10-year risk less than 10 percent, diet and lifestyle changes could be the first step—those changes could lower your risk enough that you are no longer considered a candidate for a statin.

• Older than 75 with a history of heart disease or heart problems.

• At an increased risk of side effects from a high-intensity statin—this includes:

1. People older than 75, those with multiple and/or serious medical conditions, such as impaired kidney or liver function, those with a history of stroke or muscle disorders

2. People who currently use medications that could interact with statins

3. People of Asian heritage

-The new guidelines recommend the following people consider a high-intensity statin (reduces LDL cholesterol by 50 percent or more)-

• Anyone with a very high LDL cholesterol level—190 mg/dL or greater.

• People with diabetes between 40 and 75 years old who have a high risk of heart attack and stroke—greater than 7.5 percent over the next 10 years.

• People under 75 with a history of heart disease or heart problems.

Taking the evidence for effectiveness, safety, and cost into account, we have chosen the following statins as Consumer Reports Best Buy Drugs.

 

*For people who need a moderate-intensity statin:*

· Generic atorvastatin 10 mg or 20 mg
· Generic lovastatin 40 mg
· Generic pravastatin 40 mg 
· Generic simvastatin 20 mg or 40 mg

*For people who need a high-intensity statin:*

· Generic atorvastatin 40 mg or 80 mg

* *

All of our Best Buys—atorvastatin, lovastatin, pravastatin, and simvastatin—have been shown to reduce the risk of heart attack and deaths from heart attacks, and are available as inexpensive generics. You could save more than $100 per month if you pay out-of-pocket, and you select a generic instead of a brand name statin.

Higher doses and high-intensity statins pose a greater risk of rare, but serious side effects, such as muscle breakdown that can lead to permanent kidney damage, coma, and possibly death. But some people—such as those who have very high LDL, have suffered a heart attack, or have diabetes—may require a high-intensity statin.

No matter which statin or dose you take, if you experience muscle aches and pains when taking a statin, contact your doctor immediately.

To save money, ask your doctor about splitting your statin pills. This can cut your costs substantially and is a widely accepted practice.

Cholesterol-lowering statins are used to help prevent heart disease, which can lead to heart attacks, heart failure, and death. Heart disease is the leading cause of death in the U.S., accounting for about 600,000 deaths every year, according to the national Centers for Disease Control and Prevention.

About 71 million American adults have elevated levels of LDL or “bad” cholesterol, according to the CDC. A high LDL cholesterol level increases your risk of heart disease, but it does not necessarily mean you should start on a statin, because LDL is just one risk factor out of several that determine your overall risk. Other factors that raise your risk of heart disease include older age, diabetes, having a family history of heart disease, high blood pressure, lack of exercise, whether you are obese, and whether you smoke. Your doctor should ask you about those risk factors and take them into consideration before deciding whether a statin is appropriate for you.

The use of statins has increased sharply in recent years, and they are now among the most widely prescribed medicines in the U.S. Twenty-two percent of Americans 45 years and older take a statin drug, according to the most recent data from the National Health and Nutrition Examination Survey.

As a class, statins and their related combination products generated $16.9 billion in U.S. sales in 2012. One statin, Crestor (rosuvastatin), was the third-top-selling drug in the U.S., accounting for $5.1 billion.

This analysis compares statin drugs with each other and will help you talk with your doctor about your choices and heart-disease risk.

-Drugs evaluated in this analysis-

- -

Seven statins are now available by prescription in the U.S. They are:

*Generic Name* *Brand name(s)* *Available as a generic drug?*
Atorvastatin Lipitor Yes
Fluvastatin Lescol, Lescol XL Yes (Lescol only, not Lescol XL)
Lovastatin Altoprev, Mevacor Yes
Pitavastatin Livalo No
Pravastatin Pravachol Yes
Simvastatin Zocor Yes
Rosuvastatin Crestor No

In addition, combination products containing a statin and another lipid-lowering drug are available in the U.S. These drugs are listed below.

*Generic name* *Brand name*
Atorvastatin/Ezetimibe Liptruzet
Lovastatin + Niacin Advicor
Simvastatin/Niacin-ER Simcor
Simvastatin/Ezetimibe Vytorin

The increase in statin prescriptions has prompted controversy over the appropriate use of the drugs. Some doctors and public-health advocates are concerned that too many people are being put on a statin before trying to lower their LDL cholesterol through diet and lifestyle changes.

Some people—such as those with an LDL level greater than 190 mg/dL, those who have heart disease or have previously suffered a heart attack or stroke, and those with diabetes who have a high risk of heart attack or stroke—should start taking a statin as initial therapy.

But for people who don’t fall into those categories and have a 10-year risk of heart attack and stroke that is below 7.5 percent, our medical advisers say that you should not consider a statin, unless you have a genetic condition that causes elevated cholesterol levels or a strong family history of premature heart disease.

If your risk is at or above 7.5 percent but below 10 percent, you could consider a statin, but don’t underestimate the benefit of diet and lifestyle changes. For example, regular aerobic exercise has been shown to lower LDL and raise HDL levels, as well as help you lose weight, which is also associated with a reduction in LDL and a rise in HDL levels. Those changes could lower your risk enough that you are no longer considered a candidate for a statin.

Even after years of attention to this issue, many people remain confused about what constitutes a cholesterol-lowering and heart-healthy diet. For example, many still believe that simply cutting cholesterol-laden eggs out of their diet will do the trick. It won’t if the rest of your diet is high in saturated fats from meat, margarine, butter, and other high-fat dairy products. Following a Mediterranean diet supplemented with olive oil or nuts is the only diet that has been shown in a clinical trial to reduce the risk of heart attacks and strokes. To learn more about a healthy diet, go to Consumer Reports heart health site.

Our recommendations about who should consider a statin drug are based in part on guidelines from the American College of Cardiology and the American Heart Association released in 2013. Those guidelines recommend that your doctor prescribe either a moderate- or high-intensity statin if you fall into one of four groups below. A moderate-intensity statin is expected to reduce LDL cholesterol by 30 percent to 50 percent, while a high-intensity statin would reduce LDL by 50 percent or more. (See table below).

Previous strategies focused on reducing elevated LDL cholesterol levels to very low levels. But the new guidelines look at your overall risk of a heart attack or stroke in the next 10 years as more important than LDL cholesterol levels alone. The guidelines determine your risk based on additional factors, including your age, blood pressure level, whether you smoke, are overweight, or have diabetes or other medical problems.

To calculate your risk of suffering a heart attack or stroke over the next 10 years, the new guidelines use a calculator, found here: http://tools.cardiosource.org/ASCVD-Risk-Estimator/.  It uses your age, blood pressure, gender, levels of total and HDL cholesterol, race, and whether you smoke or have diabetes to generate a risk score. 

This calculator generated controversy when it was released in November 2013. Some experts argued it might overestimate a person's risk, and could put people on a statin who don't actually need one. 

It's good to know that this and other calculators are intended only to help estimate you overall cardiovascular risk. The results are simply a guide for you and your doctor to use in deciding if you should take a statin.

The table below lists the four groups of people the new guidelines recommend should receive a statin.

-Statin benefit groups and recommendations-

*Group* *Our Recommendations*
1. This group includes anybody who has one of the following.

· History of heart disease or heart problems.
· Have had a heart attack, stroke or near-stroke (transient ischemic attack) or had a coronary stent inserted
· People with angina or peripheral artery disease 

People in this group who are under the age of 75 should take a high-intensity statin*

 

People over 75 years should take a moderate-intensity statin

2. People with LDL level of 190 mg/dL or greater

Take a high-intensity statin*
3. You’re in this group if you meet all of the following:

· Between 40 to 75 years of age with diabetes but without heart disease
· LDL level of 70 to 189 mg/dL 

If your 10-year risk of heart attack/stroke is less than 7.5 percent, guidelines recommend a moderate-intensity statin

 

If your 10-year risk of heart attack/stroke is greater than 7.5 percent, guidelines recommend a high-intensity statin

4. You’re in this group if you meet all of the following:

· Between 40 and 75 years old
· LDL level of 70 to 189 mg/dL
· Do not have diabetes or heart disease
· 10-year heart attack/stroke risk of 7.5% or higher

 

 

Take a moderate- to high-intensity statin.* For some individuals, especially those with a 10-year heart attack/stroke risk less than 10 percent, diet and lifestyle changes could be the first step—and could lower your risk enough that you don’t need a statin

 

* People who are at high risk for side effects from a high-intensity statin should instead take a moderate-intensity statin. This includes people who have multiple and/or serious medical conditions, including impaired kidney or liver function, a history of stroke, muscle disorders or problems with statins, use of medications that could interact with statins, older than 75, and Asian heritage.

The fourth group—those without heart problems or diabetes and a 10-year heart attack/stroke risk higher than 7.5 percent—is controversial because some experts think the 7.5 percent cutoff is too low. Some say it should be as high as 20 percent while others think it should be 10 percent. As noted above, the new guidelines recommend that people in this group consider a statin.

Our medical advisers say that for some people, especially those with a 10-year heart attack/stroke risk less than 10 percent, diet and lifestyle changes should be the first step. That step would include adopting a healthy diet that is low in saturated fats, trans fats, and cholesterol, and making lifestyle changes such as exercising and losing weight if you need to or quitting smoking if you are a smoker. Those changes might reduce your LDL and your heart attack/stroke risk enough that you won’t need to take a statin.

It’s also important to discuss with your doctor your individual risk factors—cholesterol level, age, family history of heart disease, exercise level, and whether you have diabetes, high blood pressure, are overweight or obese, or smoke—to help determine whether a statin makes sense in your situation. In making your decision, our medical advisers recommend that you consider the risk of side effects and also look at how taking a statin will reduce your risk. You might find that a statin will not make much difference in your 10-year risk.

All the statins have been found to reduce levels of LDL cholesterol. And all but two have been found to lower the risk of heart attack and death from heart disease in people with moderate to high risk of heart disease and those who have heart disease or have had a heart attack. But statins differ in their ability to reduce LDL cholesterol. And the evidence is stronger for some statins when it comes to reducing your risk of heart attack or death from heart disease or stroke.

Statins also vary widely in cost. As mentioned, five are now available as generics, and you can save a significant amount of money if you and your doctor choose one of them. This may also help you stay on the drug.

Of course, price is not the only important factor in choosing a statin. As we previously discussed, you and your doctor will want to consider:

· Your risk factors for heart disease, heart attack, and stroke.
· The strength of evidence for each statin.
· The possibility of drug interactions with medicines you are already taking.

-If you have had a heart attack-

People who have already suffered a heart attack are at very high risk of another (possibly fatal) heart attack and generally benefit from lowering their LDL cholesterol as much as possible.

People who have had a heart attack will probably be prescribed several different kinds of drugs, including a statin, and lifestyle changes will be strongly urged. In studies involving heart patients, atorvastatin has been shown to reduce the risk of second heart attacks and deaths, strokes, and major heart problems. In addition, atorvastatin may be a better option for people who have had a heart attack and need greater LDL reduction.

-Strokes-

Several statins—atorvastatin, pravastatin, simvastatin, and rosuvastatin (Crestor)—have been proven to prevent strokes. The statins are also widely prescribed for people who have had a stroke or “ministroke,” which doctors call a transient ischemic attack, or TIA. An analysis by the Cochrane Collaboration found that the available evidence indicates overall that statins reduce the risk of fatal and nonfatal strokes by 22 percent.

-What about the other statins?-

The remaining statins include fluvastatin (Lescol and Lescol XL), pitavastatin (Livalo), and rosuvastatin (Crestor). Fluvastatin and pitavastatin have not been clearly proven to reduce heart attacks, strokes, or deaths. Crestor has been shown to reduce heart attacks and deaths, but there is no reason to take it instead of generic atorvastatin, which is about half the price, depending on dose.

If you fall in one of those groups and you and your doctor have decided a *moderate-dose statin* is appropriate, we choose the following as Best Buys, based on effectiveness, safety, and cost:

· *Generic atorvastatin 10 mg or 20 mg*
· *Generic lovastatin 40 mg*
· *Generic pravastatin 40 mg or 80 mg*
· *Generic simvastatin 20 mg or 40 mg*

For people who need a *high-dose statin*, we selected the following as a Best Buy:

· *Generic atorvastatin 40 mg or 80 mg*

-Warning about high doses-

- -

There is one other important issue you should know about as you and your doctor choose a statin. For people who are at high risk of heart attack–for example, if you have diabetes, are a smoker and have elevated LDL levels–studies indicate that the lower your LDL, the lower the risk of heart attack and stroke.

Since higher doses and high intensity statins reduce LDL cholesterol more, the hypothesis has been that they are better and should be used more liberally. And the new ACC/AHA guidelines recommend high-intensity statins if a person does not have any conditions or problems that prohibit their use.

But higher doses and high-intensity statins come with more side effects. Higher doses of all statins have been linked to muscle aches, soreness, tenderness, or weakness. Studies indicate that between one in 20 to one in 10 people who take a statin—regardless of dose—experience these symptoms, and up to 10 percent in some studies have not been able to tolerate an 80 mg dose.

Higher doses have also been linked to an increased risk of a life-threatening form of muscle breakdown called rhabdomyolysis. This can lead to permanent kidney damage, coma, and death.

So even if you fall into a category that should receive a high-intensity statin, we advise caution and careful monitoring for the occurrence of side effects.

-What about low-intensity statins?-

- -

If you are already taking a low-intensity statin, such as simvastatin 10 mg, pravastatin 10 mg or 20 mg, lovastatin 20 mg, fluvastatin 20 mg or 40 mg, or pitavastatin 1 mg, the new guidelines do not mean that you should necessarily switch to a moderate- or high-intensity statin. This could be a good time to review your risk factors with your doctor to figure out your current risk level and determine whether or not it makes sense to change to a different statin. But if you and your doctor are satisfied that the low-intensity statin you are on is working for you, there’s no reason to switch.

-How effective are statins?-

* *

Statins reduce the risk of a first heart attack and repeat heart attacks, as well as the risk of death from heart attacks and other forms of heart disease. But some have been studied more extensively than others in terms of both their effectiveness and their safety. And ongoing research continues to define how the statins work and how they differ.

Although all statins reduce LDL cholesterol levels, they have also been evaluated by three other criteria to determine if the drug:

· Reduces nonfatal heart attacks
· Reduces deaths from heart attacks
· Reduces the chance of death due to other causes, including stroke and other forms of heart disease

*Reduction of heart attacks*

Four statins—atorvastatin (Lipitor and generic), lovastatin (Altoprev, Mevacor, and generic), pravastatin (Pravachol and generic), and simvastatin (Zocor and generic)—have been proven to reduce the risk of heart attack over three to five years of use. And rosuvastatin (Crestor) has been shown to reduce the risk of heart attack over 1.9 years of use. But you should know that the longest studies have only looked at several years of use and no studies have looked at the impact of taking these drugs for 20 to 30 years or longer, the length of time that many people will wind up taking the medicines.

Fluvastatin (Lescol and Lescol XL) and pitavastatin (Livalo) have not been shown to prevent heart attacks and strokes. So we can’t recommend either one.

It’s important to note that although statins reduce the risk of a first or a repeat heart attack, they do not completely eliminate the possibility of these conditions.

In one three-year study that looked at preventing a first heart attack, 5 percent of people who took a placebo had a heart attack compared to 3 percent of those who took a statin. And another recent study found that while people who did not have cardiovascular disease, but did have one or more risk factors (and/or diabetes), benefitted from taking a statin, the reduction in risk was not dramatic. Of those taking statins, 6 percent had a heart attack, coronary event, or stroke versus 8 percent of those taking a placebo.

*Reduction of deaths*

Four statins—atorvastatin (Lipitor and generic); lovastatin (Altoprev, Mevacor, and generic); pravastatin (Pravachol and generic), and simvastatin (Zocor and generic)—have been found to reduce deaths from heart attacks among patients with a history of heart disease or risk factors for heart disease, such as diabetes and high blood pressure.

In addition, two of the statins–pravastatin and simvastatin–have been found to reduce the overall risk of dying among people considered to be at low risk of heart disease or heart attack. A major study of lovastatin has strongly suggested a similar benefit. Atorvastatin has only been tested—and found to be effective—in reducing deaths in high-risk patients. But here, too, the evidence strongly suggests that it would be effective in reducing deaths among low-risk people as well.

One trial, called JUPITER, showed that rosuvastatin (Crestor) reduced the risk of heart attacks and death in people considered to be at low risk of heart disease or heart attack. While a decrease in heart attack, stroke, and death is good news, the actual reduction was quite small. The rate of these conditions dropped from about 2.8 percent in the placebo group to 1.6 percent in those who took Crestor. In addition, the JUPITER trial was stopped early after 1.9 years. Longer trials are needed to confirm the results.

*For people who have had a heart attack*

Starting a statin at the time of a heart attack or very soon after can reduce the risk of death substantially—treatment that is fast becoming routine. In an important head-to-head study of people who had a heart attack, a high dose of atorvastatin (Lipitor 80 mg) proved to be more effective in reducing the rate of premature death than a moderate dose of pravastatin (40 mg). In a second recent study, 80 mg of Lipitor reduced nonfatal heart attacks more than a 20 mg dose of simvastatin, but there was no significant difference in the number of deaths among people who took the two different drugs and doses.

-How safe are statins?-

* *

Overall, statins appear to be quite safe. But they can have two important adverse effects: muscle tissue damage and liver damage. We discuss those safety concerns in more detail below.

Statins also pose a small risk of type 2 diabetes. The FDA added that risk to the labeling of all statins in 2012 after reviewing several studies that had found an increased risk of elevated blood sugar levels and diabetes in people who took the medications. For example, an analysis of 13 studies published in the journal Lancet in February 2010 found a 9 percent increased risk of diabetes in people who used statins. Or looked at another way, there would be one extra case of diabetes for every 255 people who took a statin for four years.

The FDA says statins can also cause memory loss, forgetfulness, and confusion. The FDA, which added this risk to the labeling of statins in February 2012, said studies and reports it has received indicate there have been rare cases of people who developed memory loss or impairment after taking the medications. Some people developed memory problems one day after taking a statin while others did not experience any problems until they had been taking a statin for years. The problems did not appear to be linked to higher doses of statins. The memory problems, which occurred in people over the age of 50, went away when the statin was stopped. In addition, as we previously noted, the long-term effects of taking statins for decades has not been assessed. So while these drugs appear to be relatively safe over several years of use, it’s uncertain if taking the medicines for 20 to 30 years or longer raises any unique concerns.

Because of the risk for birth defects, women who are pregnant or trying to become pregnant should not take any statin drug. Women who are breast feeding should not take a statin as well.

*Muscle tissue damage*

As we’ve previously noted, statins can cause muscle aches, soreness, tenderness, or weakness in up to 5 to 10 percent of people taking them. This includes people taking lower doses, although low doses (10 mg and 20 mg) are much less likely to cause problems.

The symptoms of muscle problems include unexplained muscle weakness or pain, feeling very tired even though you’ve slept well, nausea and vomiting, stomach pain, and brown- or dark-colored urine. Consult your doctor immediately if you begin to have any of those symptoms. These symptoms usually go away within days or weeks after you stop taking the drug. But they could be signs of a rare, life-threatening form of muscle breakdown called rhabdomyolysis. This can lead to permanent kidney damage and coma. One statin, cerivastatin (Baycol), was withdrawn from the U.S. market in 2001 because it caused several deaths due to rhabdomyolysis.

Larger doses of statins raise the risk of muscle aches, weakening, and rhabdomyolysis, as discussed below in Differences among statins section. Taking a statin in combination with certain other drugs (gemfibrozil, niacin, and verapamil; check with your doctors for a list of others) can also significantly increase the risk of muscle damage and rhabdomyolysis. For the same reason, several additional drugs should not be taken with simvastatin, including:

· some antibiotics (erythromycin, clarithromycin, telithromycin)
· some antifungal medications (itraconazole, ketoconazole, posaconazole)
· cyclosporine, an immunosuppressant
· danazol (used to treat endometriosis)
· HIV protease inhibitors
· nefazodone, an antidepressant

Doses of simvastatin greater than 20 mg per day increase the risk of rhabdomyolysis when used in combination with amiodarone, a drug for treating an irregular heartbeat, amlodipine (used to treat high blood pressure), and ranolazine (used to treat angina).

The cholesterol-lowering drug ezetimibe (Zetia) has been associated with muscle aches and rhabdomyolysis when used on its own and in combination with statins.

Other factors that increase the risk of rhabdomyolysis include alcoholism, low phosphate levels, extreme exercise (such as running a marathon), and the use of illegal drugs, such as cocaine, heroin, and PCP.

*Liver problems*

Liver problems while taking a statin are uncommon, and when it occurs it’s usually mild. Nevertheless, the FDA advises patients prescribed a statin to have liver function tests before starting treatment. Contact your doctor immediately if you develop signs of liver problems, which include unusual fatigue or weakness, loss of appetite, dark-colored urine, or your skin or whites of your eyes begin to turn yellow.

*Differences among statins*

Overall, statins at low doses do not differ with respect to the risks of these adverse effects. Generally, people taking 10 mg or 20 mg of any of the statins are at very low risk of muscle or liver problems. But studies in recent years have raised concerns about muscle damage associated with high doses of some of the statins. The largest study of the safety of a statin followed 8,245 people who took generic lovastatin in doses of 20 mg, 40 mg, or 80 mg for four years. The incidence of muscle and liver problems increased with increasing doses.

The available evidence indicates the highest dose of simvastatin—80 mg—poses an increased risk of muscle problems and rhabdomyolysis, so the FDA recommends that the 80 mg tablet not be used except in people who have already been taking it without problems for a year or longer.

Most experts think–and the evidence so far strongly suggests–that all the statins have the potential to cause muscle problems at high doses. But until definitive studies are done, it is not clear whether some statins now on the market may pose more of a risk than others.

Finally, studies have found that grapefruit juice can enhance the absorption of statin drugs. While no studies have found any ill effects from this, in theory it could increase the potential for muscle and liver problems, or other minor side effects. If you are taking a statin and enjoy grapefruit juice, talk with your doctor.

*Age, race, and sex differences*

Women, people over 65, and members of various ethnic groups have been under-represented in the major studies of statins. But one review of the studies suggests that the drugs are equally effective and safe in men, women, and people over 65.

But the benefits of statins are uncertain in women who have very marginally elevated LDL and do not already have heart disease or other risk factors. We advise women who fall into this category to discuss this issue with their doctor. In addition to your LDL level, the discussion should also focus on your overall heart disease risk, based on whether you have other risk factors (55 or older, diabetes, family history of heart disease, high blood pressure, lack of exercise, overweight or obese, smoker). Bear in mind that at any particular age and LDL level, women generally have a much lower risk of heart disease than men. So if your risk is low and your doctor suggests a statin, you should ask whether it’s really necessary at this point in your life.

And as we have previously stated, women who are pregnant, trying to become pregnant, or breastfeeding should not take any statin drug.

If you are of Asian heritage (Filipino, Chinese, Japanese, Korean, Vietnamese, or Asian-Indian), you should know that the labeling for rosuvastatin (Crestor) notes that studies have found levels of the drug that were twice as high in Asian people compared with Caucasians. The labeling advises that the dosage of the drug be adjusted accordingly for Asian people. Some advise that people of Asian heritage begin initially with a 5 mg dose.

All of our Best Buys—atorvastatin, lovastatin, pravastatin and simvastatin—have been shown to reduce the risk of heart attack and deaths from heart attacks, and they are all available as inexpensive generics. You could save more than $100 per month if you pay out-of-pocket and you choose a generic instead of a brand name statin.

-If you and your doctor have decided a moderate-intensity statin is appropriate, we choose the following as Best Buys, based on effectiveness, safety, and cost-

 

*• *Generic atorvastatin 10 mg or 20 mg

*• *Generic lovastatin 40 mg

*• *Generic pravastatin 40 mg 

*• *Generic simvastatin 20 mg or 40 mg

* *

*For people who need a high-intensity statin, we selected the following as a Best Buy*

* *

*■ *Generic atorvastatin 40 mg or 80 mg

* *

If you currently take one of the high-intensity statins Crestor or Lipitor, but you don’t meet the ACC/AHA’s criteria for such a potent statin, a switch to one of our moderate-intensity Best Buy statins could save you thousands of dollars over the many years you may have to take a statin.For example, for people with health insurance plans that require a co-pay of $25 for a brand-name drug, such as Crestor, vs. a $7 co-pay for generic simvastatin, that represents an $18 difference, which amounts to a savings of $216 per year, or $1,080 over 5 years. For people who are without health insurance or adequate drug coverage, the savings would be much more. Talk to your doctor about whether switching makes sense in your case.

-People with special considerations-

 

The table below presents statin recommendations for people who take medications for specific medical conditions. If you have one of these conditions, you should discuss it with your doctor so he or she can help you determine which statin is the safest and most effective for your situation.

In particular, medicines for HIV and AIDS and those used to prevent the rejection of transplanted organs can increase the toxicity of statins. Statins can also increase the effect of blood thinners, such as warfarin (Coumadin and generic), and can interact with many other medications, including those used to control blood pressure.

This is not a comprehensive list. Your doctor may advise you to take a particular statin if you have other conditions or chronic diseases. It’s wise to tell your doctor about any prescription or nonprescription medicine and dietary supplements you are taking, as well as any medical conditions you have. And you should always carefully read the labeling or package insert that comes with your medicine. It contains essential information about how to take the medication and side effects and drug interactions you should be aware of.

-*Statin Choices for People With Special Considerations*-

*Condition or other drugs you may be taking* *Frequently recommended statins^1* *Comment*
Kidney transplant patients taking cyclosporine · Fluvastatin (Lescol)
· Pravastatin (Pravachol and generic)

Both are safe and effective. Lescol is less proven than pravastatin.
HIV positive patients taking protease inhibitors^2 · Atorvastatin (Lipitor and generic)
· Fluvastatin (Lescol)
· Pravastatin (Pravachol and generic)

Low doses are strongly advised.
Patients taking gemfibrozil (Lopid) (a type of cholesterol-lowering drug) · Atorvastatin (Lipitor and generic)

Gemfibrozil combined with a statin increases the risk of rhabodomyolysis, which can lead to kidney failure and death.
Patients taking the blood thinner warfarin (Coumadin and generic) · All statins

May require adjustment in dose of warfarin.

1. Because they have been shown effective in this population of patients.

2. Protease inhibitors include indinivir, nelfinavir, ritonavir, saquinavir, amprenavir, and the combination drug lopinavir/ritonavir.

Ezetimibe (Zetia) has racked up more than $1.1 billion in sales, but our medical advisers recommend skipping it and combination medications that contain it, such as Liptruzet and Vytorin (See box below).

Simcor, an extended-release combination of simvastatin and niacin, has been associated with an increase in adverse events that cause people to stop taking the drug compared with those who took simvastatin alone.

There is another combination tablet available that contains a statin and a drug used for treating high blood pressure for people who have both conditions.

The brand name of that drug, which we do not evaluate in this report, is Caduet. It is a combination of the calcium channel blocker amlodipine (Norvasc and generic) and atorvastatin (Lipitor and generic).

-Skip Liptruzet, Vytorin, Zetia-

Since the new guidelines focus on preventing heart attacks and strokes—not LDL lowering—there is no longer any reason to take Liptruzet, Vytorin, or Zetia.

Zetia (ezetimibe) is a different type of cholesterol-lowering medication than a statin. It decreases cholesterol absorption in the intestines. But it has not been shown to reduce heart attacks or strokes.

Vytorin combines simvastatin with ezetimibe in a single pill. Liptruzet is a combination of atorvastatin and ezetimibe. But there is no evidence that either Liptruzet or Vytorin works better than the statin alone to prevent heart attacks or strokes.

Two studies cast doubt on the benefits of Vytorin. The first was a two-year study that showed Vytorin was no better than simvastatin alone in reducing plaque buildup in arteries. The second was a five-year study that showed Vytorin did not reduce heart attacks or strokes compared to a placebo.

Merck, the manufacturer of Liptruzet, says the combo medication has not been proven to reduce the risk of heart attacks or strokes more than atorvastatin alone.

Our evaluation is based in part on an independent scientific review of the studies and research literature on statin drugs conducted by a team of physicians and researchers at the Pacific Northwest Evidence-Based Practice Center. This analysis reviewed 347 studies, including 225 clinical trials, 80 observational studies, and 21 systematic reviews. The analysis also included studies conducted by the drugs’ manufacturers. This effort was conducted as part of the Drug Effectiveness Review Project, or DERP. DERP is a first-of-its-kind, multistate initiative to evaluate the comparative effectiveness and safety of hundreds of prescription drugs.

This update of our previous statin report also relied on a recent review of combination therapies conducted for the Agency for Healthcare and Research Effective Healthcare Program. It is available here.

The monthly costs we cite were obtained from a health-care information company that tracks the sales of prescription drugs in the U.S. Prices for a drug can vary quite widely. All the prices in this report are national averages based on sales in retail outlets. They reflect the cash price paid for a month’s supply of each drug in October 2013.

Consumer Reports selected the Best Buy Drugs using the following criteria. The drug had to:

• Be in the top tier of effectiveness among the seven statins

• Have a safety record equal to or better than other statins

• Have an average price for a 30-day supply that is lower than the most costly statin meeting the first two criteria

The Consumers Reports Best Buy Drugs methodology is described in more detail in the Methods section at www.CRBestBuyDrugs.org.

1. Anonymous, MRC/BHF Heart Protection Study of cholesterol lowering therapy and of antioxidant vitamin supplementation in a wide range of patients at increased risk of coronary heart disease, death, early safety, and efficacy experience. European Heart Journal, 1999. 20: p.725-41.

2. Anonymous, Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. New England Journal of Medicine, 1998. 339: p.1349-57.

3. Arnett, D.K., et al. Twenty year trends in serum cholesterol, hypercholesterolemia and cholesterol medication use, 1980-2002, Circulation (December 20, 2005), Vol. 112.

4. Bradford, R.H., et al. Expanded clinical evaluation of lovastatin (EXCEL) study design and patient characteristics of a double blind, placebo controlled study in patients with moderate hypercholesterolemia. American Journal of Cardiology, 1990. 66: p.44B-55B.

5. Bradford, R.H., et al. Expanded Clinical Evaluation of Lovastatin (EXCEL) study results. I. Efficacy in modifying plasma lipoproteins and adverse event profile in 8,245 patients with moderate hypercholesterolemia [see comments]. Archives of Internal Medicine, 1991. 151: p.43-9.

6. Bradford, R.H., et al. Expanded clinical evaluation of lovastatin (EXCEL) study results III . Efficacy in modifying lipoproteins and implications for managing patients with moderate hypercholesterolemia. American Journal of Medicine, 1991. 91:p.18S-24S.

7. Bradford, R.H., et al. Efficacy and tolerability of lovastatin in 3,390 women with moderate hypercholesterolemia. Annals of Internal Medicine, 1993. 118: p.850-5.

8. Bradford, R.H., et al. Expanded Clinical Evaluation of Lovastatin (EXCEL) study results, two year efficacy and safety follow up. American Journal of Cardiology, 1994. 74: p.667-73.

9. Cannon, C.P., et al. Intensive and moderate lipid lowering with statins after acute coronary syndromes. New England Journal of Medicine, 2004. 350(15): p.1495-1504.

10. Cannon, C.P., The IDEAL cholesterol: lower is better, JAMA (Nov. 16, 2005), 294:2492-2494. Carrol, M.D., et al. Trends in serum lipids and lipoproteins of adults, 1960-2002, JAMA (Oct. 12, 2005), Vol 294: 1773-1781.

11. Davidson, M.H., et al. Lipid-altering efficacy and safety of simvastatin 80mg/day: worldwide long-term experience in patients with hypercholesterolemia. Nutrition Metabolism & Cardiovascular Diseases, 2000. 10(5): p.253-62.

12. de Lemos, J.A., et al. Early Intensive vs. a Delayed Conservative Simvastatin Strategy in Patients With Acute Coronary Syndromes: Phase Z of the A to Z Trial. JAMA, 2004.

13. Downs, J.R., et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels results of AFCAPS/ TexCAPS. Air Force/Texas Coronary Atherosclerosis Prevention Study. JAMA, 1998. 279: p.1615-22.

14. “Drugs for Lipids,” The Medical Letter (February 2008), Issue 66.

15. Fox. R., et al. Ezetimibe and statin-associated myopathy, Ann. Int. Med (April 2004), Vol. 140: 671-672.

16. Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, et al; National Heart, Lung, and Blood Institute. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110:227-39.

17. Heart Protection Study Collaborative Group, MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet, 2002. 360: p. 7-22.

18. Kent, D.M. Stroke–an equal opportunity for the initiation of statin therapy. New England Journal of Medicine (Aug. 10, 2006); 355: 613-615.

19. LaRosa, J.C., J. He, and S. Vupputuri. Effect of statins on risk of coronary disease: a metaanalysis of randomized controlled trials. JAMA, 1999. 282(24): p.2340-6.

20. Paaladinesh, T., et al. Primary prevention of cardiovascular diseases with statin therapy; a metaanalysis of randomized controlled clinical trials, Archives of Internal Medicine (Nov. 27, 2006); 166:2307-2313.

21. Pedersen, T.R., et al. High-dose atorvastatin vs. usual dose simvastatin for secondary prevention after myocardial infarction–The IDEAL study. JAMA (Nov. 15, 2005), 294:2437-2445.

22. Pedersen, T.R., Randomised trial of cholesterol lowering in 4,444 patients with coronary heart disease The Scandinavian Simvastatin Survival Study (4S). Lancet, 1994. 344: p.1383-1389.

23. Sacks, F.M., et al. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. Cholesterol and Recurrent Events Trial investigators. New England Journal of Medicine, 1996. 335(14): p. 001-9.

24. Serruys, P., et al. The Lescol (R) Intervention Prevention Study (LI PS): A double-blind, placebo-controlled, randomized trial of the long-term effects of fluvastatin after successful transcatheter therapy in patients with coronary heart disease. International Journal of Cardiovascular Interventions., 2001. 4(4): p.165-172.

25. Serruys, P.W., et al. Fluvastatin for Prevention of Cardiac Events Following Successful First Percutaneous Coronary Intervention: A Randomized Controlled Trial. JAMA, 2002. 287:p.3215-3222.

26. Sever, P.S., et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial—Lipid Lowering Arm (ASCOT-LLA): a multicentre randomized controlled trial. [comment]. Lancet, 2003. 361(9364): p. 1149-58.

27. Sever, P.S., et al. Rationale, design, methods, and baseline demography of participants of the Anglo-Scandinavian Cardiac Outcomes Trial. ASCOT investigators. Journal of Hypertension, 2001. 19(6): p.1139-47.

28. Sever, P.S., et al. Anglo-Scandinavian Cardiac Outcomes Trial: a brief history, rationale, and outline protocol. Journal of Human Hypertension, 2001.15 (Suppl 1): p.S11-2.

29. Sharma M, Ansari MT, Abou-setta AM, Soares-Weiser K, Ooi TC, Sears M, et al., Systematic Review: Comparative Effectiveness and Harms of Combinations of Lipid-Modifying Agents and High-Dose Statin Monotherapy. Ann. Int. Med. 2009;151.

30. Shepherd, J., et al. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. New England Journal of Medicine, 1995. 333(20): p.1301-7.

31. Taylor, F, Huffman MD, Macedo AF, Moore THM, Burke M, Davey Smith G, Ward K, Ebrahim S. Statins for the primary prevention of cardiovascular disease. Cochrane Database of Systematic Reviews 2013, Issue 1. Art. No.: CD004816. DOI: 10.1002/14651858.CD004816.pub5.

32. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators, high-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine (Aug. 10, 2006); 355: 549-59.

 

These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multistate settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).

*Consumer Reports has no relationship with any advertisers or sponsors on this website. Copyright © 2006-2014 Consumers Union of U.S.*

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Update your feed preferences Reported by Consumer Reports 8 hours ago.

More than five months after Oregon's botched health-insurance exchange failed to go live, concern is mounting for another, less visible state IT project that was built in conjunction with the exchange, using the same technology. Reported by Miami Herald 7 hours ago.

The Pew Research Center offers a trove of data on Millennial Americans. Conservatives rank repealing Obamacare as high as improving the economy. And yes, it's true. We can't stop obsessing about job rating answer scales. This is HuffPollster for Friday, March 7, 2014.

*MILLENNIALS IN ADULTHOOD* - A massive new report from the Pew Research Center traces the "distinctive path" being followed by the Millennial generation: "Now ranging in age from 18 to 33, they are relatively unattached to organized politics and religion, linked by social media, burdened by debt, distrustful of people, in no rush to marry— and optimistic about the future. They are also America’s most racially diverse generation. In all of these dimensions, they are different from today’s older generations. And in many, they are also different from older adults back when they were the age Millennials are now. Pew Research Center surveys show that *half of Millennials (50%) now describe themselves as political independents and about three-in-ten (29%) say they are not affiliated with any religion*. These are at or near the highest levels of political and religious disaffiliation recorded for any generation in the quarter-century that the Pew Research Center has been polling on these topics. At the same time, however, Millennials stand out for voting heavily Democratic and for liberal views on many political and social issues, ranging from a belief in an activist government to support for same-sex marriage and marijuana legalization." [Pew Research]
*Racial diversity* - Pew Research: "Millennials are the most racially diverse generation in American history, a trend driven by the large wave of Hispanic and Asian immigrants who have been coming to the U.S. for the past half century, and whose U.S.-born children are now aging into adulthood. In this realm, Millennials are a transitional generation. *Some 43% of Millennial adults are non-white, the highest share of any generation.* About half of newborns in America today are non-white, and the Census Bureau projects that the full U.S. population will be majority non-white sometime around 2043. The racial makeup of today’s young adults is one of the key factors in explaining their political liberalism. But it is not the only factor."

*Liberalism* - Pew Research: "Millennials continue to view the Democratic Party more favorably than the Republican Party. And Millennials today are still the only generation in which liberals are not significantly outnumbered by conservatives...Millennials’ liberalism is apparent in their views *on a range of social issues such as same-sex marriage, interracial marriage and marijuana legalization. In all of these realms, they are more liberal than their elders.* However, on some other social issues—including abortion and gun control—the views of Millennials are not much different from those of older adults.

*Obama approval slides among all generations* - "President Obama was swept into the White House in 2008 on a wave of support from young voters. Yet within six months of taking office, his job approval rating began to slide among all generations. Among Millennials, Obama’s job approval has *fallen from 70% in those first honeymoon months of 2009, his highest rating among any generation, to 49%* in combined surveys from January and February 2014. The falloff has been about as steep among Silents (23 points), Gen Xers (18 points) and Boomers (17 points). [Pew Research]
*REPEALING OBAMACARE A TOP CONSERVATIVE PRIORITY* - Emily Swanson: "Conservatives are just as likely to say the government's top priority this year should be repealing President Obama's health care law as to say improving the economy should take the top spot, according to a HuffPost/YouGov poll conducted ahead of the Conservative Political Action Committee's annual conference, which started Thursday. Among all Americans, improving the economy was the clear-cut winner. Asked to choose from a list, 51 percent ranked that as the No. 1 issue the government faces, while 21 percent ranked repealing the health care law at the top...People who identify as liberal or moderate were equally likely to place improving the economy at the top among those priorities, at 56 percent each. But only 40 percent of conservatives said the same. About as many -- *39 percent -- said that repealing the health care law should be at the top of the list.*" [HuffPost]

*DE BLASIO EXCELLENT/GOOD RATING AT 39 PERCENT* - Michael Howard Saul: "Thirty-nine percent of registered voters in New York City approve of Mayor Bill de Blasio's job performance two months after he took the reins of the nation's largest city, a poll from The Wall Street Journal-NBC 4 New York-Marist showed Thursday. While many New Yorkers have a favorable view of the city's new mayor, saying Mr. de Blasio cares about the average person and is fulfilling his campaign promises, they don't give him high marks as a chief executive. According to the poll, the first WSJ-NBC-Marist survey of his tenure, *10% of voters described Mr. de Blasio's job performance as excellent and 29% characterized it as good, while 37% rated it as fair and 20% said he is doing poorly*. The poll showed 5% either never heard of the mayor or were unsure how to rate him. Mr. de Blasio's job-performance rating is markedly lower than Mr. Bloomberg's at the same point after he took office in 2002. At that time, 50% approved of Mr. Bloomberg's job performance, and only 6% said Mr. Bloomberg was doing poorly in his new job." [Wall Street Journal]

*More commentary on the 'excellent-good-fair-poor' scale* -Thursday's HuffPollster, which noted polls using a scale of "excellent, good, fair or poor" *typically find smaller positive job ratings than polls that use an "approve or disapprove" scale*. The reason appears to be that some respondents hear "fair" as more neutral than negative. Spurred in part by that report, some poll watchers took to Twitter to complain using an "excellent" or "good' rating to equate with "approval:"

-DailyKos Political Director *David Nir*: "Another entry for the "why 'fair' sucks" file [link to WSJ story] Seriously, @MaristPoll...[Earlier:] The problem isn't the scale, it's the ambiguity of the word 'fair,' which means too many things in English." [@DKElections here and here]

-Democratic pollster *Nick Gourevitch*: "Common terminology mistake in this article on Mayoral job ratings. *Excellent/good ≠ approve. Fair/poor ≠ disapprove*. http://t.co/7yLaBUnuMc" [@nickgourevitch]

-FiveThirtyEight's *Harry Enten*: "My general rule on fair is that about 2/3's of people who give it would disapprove, while 1/3 would approve. Just a general rule tho." [@ForecasterEnten]

-Via email, the Mellman Group's *Skip Perry* (D) offers a qualified defense of Marist's scale: "*Excellent/good/only fair/poor is a different, tougher standard than approve/disapprove* that 1) provides useful information about what voters think about the job an officeholder is doing and 2) is distinct from overall favorability. We can all think of incumbents who might be well-liked but are nonetheless endangered because voters don't think they are doing at least a 'good' job. Reporters need to be careful about how they write about EGFP data but that's the case with all poll reporting, where favorability and job approval ratings, RV and LV surveys, etc. are routinely conflated."

*False equivalence* - The comments by Gourevitch and Perry get to the heart of the issue: Whatever their merits, the "excellent-good-fair-poor" and "approve-disapprove" scales produce different measurements, even if both ask explicitly about an officeholder's job performance. Yet *journalists and other poll watchers often treat the two types of ratings as equivalent* -- something made implicit by the use of term "approval" to describe both -- putting those officeholders with the misfortune of having their performance measured by the more demanding "excellent-good" scale at a disadvantage.

*HUFFPOLLSTER VIA EMAIL!* - You can receive this daily update every weekday via email! Just enter your email address in the box on the upper right corner of this page, and click "sign up." That's all there is to it (and you can unsubscribe anytime).

*FRIDAY'S 'OUTLIERS'* - Links to the best of news at the intersection of polling, politics and political data:

-The Keystone XL pipeline has wide support among Americans. [WashPost]

--67 percent of Americans say they would vote out all current members of Congress, including their own senators and representative. [Fox]

-Another Pennsylvania poll shows Gov. Tom Corbett (R) with a low (33 percent) job rating and Thomas Wolf far ahead among those vying for the Democratic nomination. [RMU]

-The Bloomberg Consumer Comfort index has improved for four straight weeks. [Bloomberg]

-Half of Americans say Joe Biden is not qualified to be President. [YouGov]

-A Hart(D)/McIntuff(R) poll finds most Americans want to repair Obamacare rather than repeal it. [Fiscal Times]

-A majority of the uninsured (55 percent) say they will get health insurance. [Gallup]

-Two surveys find few uninsured Americans signing up via the new health insurance marketplac. [WaPost]

-Democrats Stan Greenberg and James Carville explain why they see hope for Democrats in 2014 from the new Post/ABC poll. [National Memo]

-Ron Brownstein says the concentration of the Democrats' demographic coalition in urban areas leaves them vulnerable to losing the Senate in 2014. [National Journal]

-Dancing Statistics demonstrates statistical concepts through dance videos. [Flowing Data] Reported by Huffington Post 7 hours ago.