Study: 'Obamacare' repeal-only would make 30M uninsured

December 7, 2016, 10:54 am

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*By The Canadian Press*

WASHINGTON — Repealing President Barack Obama's health care law without a replacement risks making nearly 30 million people uninsured, according to a study released Wednesday.

Separately, a professional group representing benefit advisers warned congressional leaders of the risk of "significant market disruption" that could cause millions of Americans to lose their health insurance.

Republicans dismiss such dire scenarios, saying that they are working on replacement legislation... // Read Full Article Reported by CJME 1 hour ago.

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Ayurvedic hospital patients can seek health cover, says govt

December 7, 2016, 11:27 am

≫ Next: Doctor In Hot Water For Asking Patients To Fund His Retirement

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The guidelines specify 20 different kinds of ailments that can be included in a health insurance scheme. Reported by DNA 50 minutes ago.

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Doctor In Hot Water For Asking Patients To Fund His Retirement

December 7, 2016, 11:27 am

≫ Next: Immediate Harm Even from "Delayed" Health Reform Repeal, Urban Institute Finds

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Dr. Myron MacDonald -- a West Vancouver, Canada, general practitioner who, after 48 years in practice, sent his patients a two-page letter asking for their financial help so he could afford retirement -- may have gotten himself in trouble.

MacDonald, who described his career as “a pleasure, not a chore,” said he didn’t make much money during his career because he ran a low-volume practice that allowed him to spend time with each patient. He wrote to his patients that he has limited savings and no pension and asked them to assist him by donating whatever they could.

“Any amount will be of help to me,” he wrote. “Perhaps $20 to $30 a month on your credit card could work for you.”

But the letter may have landed him in hot water. He is facing scrutiny from the regulatory B.C. College of Physicians and Surgeons. The outgoing message on MacDonald’s office phone said the office has been closed. He did not respond to messages left by The Huffington Post.

MacDonald, 74, billed $163,978 last year, according to the Medical Services Commission. The doctor told the Vancouver Sun said that his business expenses ate up much of that money.

But according to The Sun, B.C.’s College of Physicians and Surgeons, which regulates the medical profession in the province, slammed MacDonald’s actions.

In an emailed statement the regulatory body released, it said that MacDonald’s request violated Canadian medical principles.

“Any physicians who request money from patients to support him or her in retirement would be contravening a foundational principle which every physician is required to abide by: Do not exploit patients for personal advantage,” a spokesperson wrote. The spokesman said the college expected to resolve the matter within the next few days and that there would be no formal investigation or discipline if MacDonald took steps to make things right.

Canada’s health care is provided to all citizens through socialized health insurance plans. It is publicly funded and administered on a provincial or territorial basis, within guidelines set by the federal government.

MacDonald was one of the co-founders of Greenpeace and served as a medic on the environmental group’s campaigns to save the whales in the 1970s. According to his letter, he spent four years circumnavigating the globe by sailboat after his time with Greenpeace.

His letter also reminds patients to take their Vitamin D, and promises to continue nagging them to do so.

Here is the letter he sent to patients. What do you think, readers?

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 50 minutes ago.

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Immediate Harm Even from "Delayed" Health Reform Repeal, Urban Institute Finds

December 7, 2016, 2:44 pm

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Congressional Republicans claim that, when they repeal the Affordable Care Act (ACA) early next year, they can avoid hurting consumers by delaying the elimination of its Medicaid expansion and marketplace subsidies for two years or more. This delay, they say, would ensure that "no one is worse off," as House Speaker Paul Ryan put it, while Republicans supposedly craft a replacement that will be available before the ACA's coverage provisions expire. A new Urban Institute study, however, reveals the immediate and disastrous consequences of this approach.Specifically, 4.3 million more people would become uninsured and insurers would suffer sizable financial losses in 2017. That's because the Republican repeal plan would swiftly trigger a "near 'death spiral'" in the individual health insurance market that would accelerate during 2018, Urban finds, as insurers withdraw from the market or raise premiums significantly and relatively healthy people drop their coverage. Urban estimated what would happen if legislation similar to the Republican budget reconciliation bill that repealed major parts of the ACA (which President Obama vetoed in January) became law. Urban assumed that the premium tax credits and cost-sharing reductions now available through the ACA's marketplaces would continue for two years, while the requirement for people to have coverage or pay a penalty (the "individual mandate") and for employers to offer coverage to their workers or pay a penalty (the "employer mandate") would end immediately. Urban assumed that the ACA's market reforms -- such as the guarantee that insurers will offer coverage to people with pre-existing health conditions without charging them higher premiums -- remain in place.Urban concluded that the number of uninsured would immediately rise by 4.3 million in 2017 because there would no longer be an individual mandate that required people to buy coverage. The "risk pool" -- those covered in states' individual health insurance markets -- would worsen right away because healthier people would be likelier to drop their plans. Consequently, insurers in the individual market stand to lose nearly $10 billion in premium revenue in that year alone as they would have to continue to accept people with pre-existing health conditions, charge them the same as healthier people, and cover the "essential health benefits." These insurers, who already endured a volatile transition period as the ACA was implemented, would fall an estimated $3 billion short of covering their costs under this scenario, Urban found. Many would flee the market.And that's just the short-term damage -- before Urban accounts for the repeal of the Medicaid expansion and marketplace subsidies after the two-year delay. By 2019, the number of uninsured would more than double, rising by 29.8 million, Urban estimates, and the number of people enrolled in coverage in the individual market would drop from 19.3 million to 1.6 million. The Urban analysis shows the devastating effect of the likely congressional Republican plan that repeals the ACA without replacing it. Even a "delayed" repeal would have immediate, harmful, and costly consequences for people's access to coverage and for states' individual health insurance markets.
This post originally appeared on Off the Charts, the Center on Budget and Policy Priorities' blog

*More on this topic:*

Republican Health Reform Repeal Plan Would Leave 30 Million More Uninsured

Impact of Affordable Care Act Repeal

Commentary: GOP's Health Reform Strategy Amounts to Repeal Without Replacement

Consumers Should Keep Enrolling in Marketplace Coverage

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 3 days ago.

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Watch Out for Even More Tax Breaks -- for the Rich

December 8, 2016, 2:14 am

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(Photo: AP/Matt Rourke)

This article will appear in the Winter 2017 issue of The American Prospect magazine. Subscribe here.

Think, if you will, about taxing and spending.

The former—taxing—occurs when the government levies some claim on your income. It could be a local sales tax on a tube of toothpaste, a Medicare or Social Security deduction from your paycheck, or an income tax check to the federal IRS. Spending is what the government does with tax revenue. Local governments spend your property taxes on public schools; the feds finance social insurance, defense, the safety net, and so on.

Many people think that taxing and spending, while complementary, are entirely distinct.

Not so. There’s an important way in which the federal government spends through the tax code. The technical term is tax expenditures. These include tax credits, deductions, and exemptions. You can’t begin to understand the scope, the inequities, and some of the venerable benefits of our tax system without getting into these particular weeds. Moreover, in the age of Trump, we’re going to need to keep a very close eye on such provisions, which are almost certain to grow, and to grow even less equitable.

Tax expenditures reduce the amount of taxes owed based on some policy goal or preference. If you’re a homeowner, you probably deduct your mortgage interest from your tax bill. That’s a tax expenditure, one that diverted $75 billion from the coffers of the U.S. Treasury in 2016. If you get your health insurance through your job, the fact that its value doesn’t go into your tax base is another tax expenditure; in fact, it’s the largest single one, amounting to $216 billion forgone this year.

The chart below compares the combined cost of the tax code’s individual and corporate tax expenditures with other government spending. Tax expenditures cost about $300 billion more than either of the major government health-care programs (Medicare and Medicaid) or Social Security, and about as much as all federal discretionary spending on defense, other health-care programs, education and training programs, transportation systems, diplomacy, science, and much more combined.

In fact, the distinction between a tax expenditure and straight-up spending is sometimes meaningless. Consider the Child Care and Development Fund, a spending program that helps certain families pay for child care. Now consider the child-care tax credit. Both programs help families offset the cost of child care. Why do we have both, and what implications does that have on policy and politics?

First, given the conservative mantra of “spending bad, tax cuts good,” many politicians in both major political parties are much more comfortable with tax expenditures than direct spending. But that ideological bargain leads to a lot of spending through the tax code that’s both wasteful and inequality-inducing. As Suzanne Mettler has shown in her book The Submerged State, it also denies government credit for the instances of good policy, since a tax break is experienced as a refund rather than as a direct government benefit.

The waste comes from subsidizing actions that would happen even without the subsidy. Wealthy people would save, and buy houses and health care, without a tax break. And yet—and this is the inequitable part—not only do they get to take tax deductions for these activities, they get to take larger ones than lower-income people. A rich individual who faces a top marginal income tax rate of 39.6 percent would save $39.60 on her tax bill with a $100 deduction, for example, while an individual with a lower top marginal tax rate, say 25 percent, would only save $25 from the same deduction. The regressive result is shown in the next figure: Half of the benefits of the ten largest tax expenditures go to the richest fifth of households.

The mortgage interest and property tax deductions are two popular expenditures that have this regressive effect: 80 percent of total spending on these two deductions goes to households with incomes over $100,000. Households with incomes over $200,000 receive four times as much support from the federal government as households with incomes below $20,000. It is in this way that our tax system not only fails to offset, but exacerbates market-driven income inequality.

Such tax breaks litter the code. There’s bonus depreciation (a provision that allows businesses to deduct the cost of business investments faster than those investments lose value in real life), tax deferral for multinationals on overseas profits, and “like-kind exchanges” that enable real-estate owners to avoid paying capital gains taxes, among many others. Tax breaks are especially notorious in the real-estate industry.

Hmm … a real-estate owner who taps into such loopholes to avoid tax liability …. That sounds familiar.

President-elect Donald Trump and his merry band of billionaires are all too familiar with tax expenditures and are likely to use them to great—and by “great,” we mean “terrible”—effect. A perfect example is their infrastructure plan. Instead of the usual approach of allocating funds to pay for much-needed upkeep of our stock of public goods, they propose providing about $140 billion in tax credits for private infrastructure investments. Investors would shoulder only a $30 billion burden, “but would receive all the profits,” as our colleagues at the Center on Budget and Policy Priorities have explained, “effectively privately owning and operating the projects and charging the public to use them.” Since investors would only finance projects, like toll roads, with these spun-off user fees, such a plan would likely cause essential repairs to school facilities and interstate highways to fall by the wayside.

We expect the Trump administration to offer similarly bad tax-expenditure ideas in their quest to repeal and replace the Affordable Care Act. They’re likely to turn to Health Savings Accounts (HSAs), a tool that, as health expert Edwin Park points out, offers “unprecedented tax sheltering benefits to high-income individuals.” In an HSA, people with high-deductible health plans can make tax-deductible contributions to their accounts, earnings can grow tax-free, and withdrawals to pay for health care are also tax-exempt. Look for team Trump to expand these amped-up tax shelters by raising the maximum annual contribution to HSAs and allowing people to apply HSAs not just to out-of-pocket costs (which are all that HSAs currently cover), but to premiums as well.

Progressive tax wonks tend to prefer credits over deductions, as credits directly reduce individual or corporate tax bills by a specific amount. A $100 credit is generally worth $100 both to people with a top marginal tax rate of 39.6 percent and to those with a top marginal rate of 25 percent. Yet they, too, can be regressive. A family with a tax liability of only $20 will only get $20 worth of benefit from a typical $100 tax credit, thus making such a credit more valuable to families with higher incomes than to lower-income people.

The exceptions to this rule are credits that are refundable, meaning that if the size of the credit exceeds a taxpayer’s tax liability, the taxpayer receives a check from the government for the balance. The Earned Income Tax Credit (EITC) and the Child Tax Credit (CTC), for instance, are effectively cash transfers that significantly reduce poverty—they lifted 9.8 million people out of poverty in 2015 and made 22 million more people less poor—while incentivizing work. These refundable credits could help even more people if policymakers strengthened the EITC for workers not raising children in the home and extended the CTC to the poorest families, especially those with young children.

Another refundable tax credit, the premium tax credit from the Affordable Care Act, helped make health insurance more affordable for more than nine million Americans as of early 2016. When you hear warnings about how the repeal of Obamacare is going to lead to millions losing coverage, the loss of this credit is one reason (as is the repeal of the Medicaid expansion).

In sum: There’s taxing, there’s spending, and then there are tax expenditures. For the most part, tax expenditures are inefficient, inequitable, opaque, and vulnerable to special-interest lobbying. The exception is refundable tax credits like the EITC, which are tantamount to direct income support for moderate-income, working Americans. (Guess which kind of tax expenditure is likely to increase under Trump?)

While spending through the tax code is not in every case problematic, the bulk of what goes on in that big, shady part of the code is wasteful and inequitable. Unfortunately, in the age of Trump, that part is sure to grow. Reported by The American Prospect 2 days ago.

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Dr. Botelho Launches a Social Media Campaign Engaging People to Speak Out About "What's Most Unfair About Healthcare"

December 8, 2016, 4:19 am

≫ Next: 5 Things For Midlifers To (Sort Of) Look Forward To In 2017

≪ Previous: Watch Out for Even More Tax Breaks -- for the Rich

Dr. Botelho calls on the mass media to launch story movements for people to share their personal experiences of "What's Most Unfair About Healthcare" and activate democratic participation, dialogue and debates about healthcare policy reforms.

Charlotte, NC (PRWEB) December 08, 2016

Healthcare is in flux. The GOP wants to repeal Medicare and the Affordable Care Act. Dr. Botelho advocates for the mass media launching of story movements to highlight what's most unfair about healthcare. A story movement gives people ongoing opportunities to share their unfortunate experiences; such a movement can generate the network power to improve healthcare policies in accordance to the people's wishes.

People want positive patient care experiences and transparent accountability with respect to safety, cost, quality and value. US Healthcare costs are the highest in the world: about 50% higher than the next country. It is only ranked 37th in the world. Healthcare costs make US corporations less competitive in a global market.

High healthcare costs reduce what people can spend on daily living and contribute to their retirement. And people with no or inadequate health insurance are at high risks of personal bankruptcies.

Both wealth inequalities and unequal access to health care contribute to health inequities. Consequently, the wealthy have the best health outcomes, and the poor have the worst outcomes.

For many people, healthcare is just a business, not a human right. They strongly believe that the free market is the only solution.

"Do people deserve the same access (equality) and outcomes (equity), whether rich or poor?" is a question that Dr. Botelho likes to ask people who oppose equity.

What's most unfair about healthcare is that we cannot agree on what it is. Closed mindsets are the greatest barriers to change. A story movement will help people listen empathically with open hearts and minds and put their political ideologies on the side.

IMPLEMENT GENDER AND HEALTH EQUITY IN ALL POLICIES
Dr. Botelho is advocating for policies based on this proposed pledge: "We, the People, Pledge our Government to use Justice, Equality and Liberty to Pursue Gender and Health Equity for the Greater Good of All,"

This pledge aims to activate people to participate in the story movement and advocate for policy changes. Dr. Botelho suggests these changes will create fair opportunities for everyone to achieve their highest human potential of health and well-being.

Join the campaign to speak out. Share stories about what’s most unfair about US healthcare.
Use Facebook and Twitter to spread the message about this story movement to 1 million people (177,717 to date).

1. Invite People to Share their Stories
Use the power of stories to make the government listen to about what’s most unfair. The people must dialogue about how to make healthcare fair, affordable and available to all.

2. Use Facebook and Twitter Accounts to help reach 1 million people. (176,000 to date: deadline Dec 31st) Click on this link to understand more about why people are deeply divided about what's most unfair about healthcare and what we can do about it.

3. Invite individuals and Facebook/twitter groups with large social reach to join this campaign.

4. Invite organizations and media outlets with large social reach to this cause

5. Invite healthcare organizations and hospitals to launch their own story movements about what's most unfair about healthcare.

Media interviews welcomed. Reported by PRWeb 2 days ago.

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5 Things For Midlifers To (Sort Of) Look Forward To In 2017

December 8, 2016, 4:59 am

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≪ Previous: Dr. Botelho Launches a Social Media Campaign Engaging People to Speak Out About "What's Most Unfair About Healthcare"

We admit it: 2016 was a rough one. But with the flip of a calendar page we have the symbol of a new beginning, a fresh start, a farewell to the crappiest year ever. Here are five things midlifers can look forward to in 2017, sort of:

1. The end of Medicare as we know it.

Traditional Medicare ― overwhelmingly loved by pretty much everyone on the planet except Paul Ryan ― is about to be blown to smithereens. No, you really shouldn’t be looking forward to that part. In Medicare’s place will be a federal voucher to help those 65+ pay the expensive premiums that seniors will be charged by commercial insurance plans. Ryan calls this voucher system “premium support.” We are more inclined to think of it as more of a reality TV show where older people with pre-existing conditions compete to find insurance in an unregulated marketplace. Kind of like “The Biggest Loser,” but without the weight loss.

So what part of this can we look forward to? The Great Mystery of what will replace traditional Medicare will finally be known!

During the interminably long election season, Donald Trump never actually said what health care for the elderly would look like after he fulfills his campaign promise of repealing Obamacare and leaving 22 million people uninsured overnight. We check Trump’s Twitter feed every day, hoping for clues.

This is what we know: When you repeal Obamacare, traditional Medicare feels the aftershocks. Ryan has said so. Under Ryan’s privatization plan, the elderly would be given a set amount of money to buy health insurance rather than traditional Medicare’s fee-for-service system ― where the government pays doctors and hospitals based on the services they provide.

How much money the elderly would get to buy insurance, the quality of the plans available, how the government would regulate them, whether this would be overseen on a state or federal level and a few billion other details have been, shall we say, unclear. Trump has said he wouldn’t mess with Medicare. Then he sat next to Ryan and nodded in agreement when Ryan said you can’t repeal Obamacare without messing with Medicare. Nod. Nod. Nod.

2. Boomers will get to dust off their protest signs.

Boomers haven’t been this riled up since the last Dylan concert where he cut the set short because, well, he felt like it. See, Nobel Prize committee ― it’s not just you he snubs.

When it comes to Medicare, boomers say “If it ain’t broke, don’t fix it.” You can expect them to take to the streets ― or at least to their landline phones to call their congressional representatives. It won’t be pretty. Whether it will be effective remains to be seen.

3. We will get to test the veracity of the infamous “third rail.”

The third rail of politics is a metaphor for an issue so hot that it is untouchable to the extent that any politician or public official who tries to mess with it will suffer politically. The American third rail has always been Social Security. You can’t touch it without getting zapped, has been the common wisdom.

Then along comes Trump, who pushes every envelope, every commonly held tradition. Just how safe will Social Security be? The Social Security fund is projected to remain solvent through 2034. After that, unless changes are made, beneficiaries could see their checks cut by about 25 percent.

Trump’s broad answer about how he would “save” Social Security for future generations has been tied to the economy. He says he will create more jobs, employ more people, and thus have more workers contributing to the Social Security fund.

And if that doesn’t happen, will there be a sizzle?

4. It will be proven that hindsight is the perfect vision.

Boomers, by factor of their sheer numbers, have redefined culture since they came of age in 1960s. To some extent, they shaped everything around their needs. But since, by and large, they’ve walked around singing “Forever Young,” nobody paid much attention to the idea that at some point, they would all have needs connected to growing older.

You can look forward to wishing you had supported more public transit so that those who don’t drive can get themselves places; demanded higher standards for nursing homes so that the turnover rate was not 75 percent for nurses and 100 percent for nurses’ aides; had insisted on relief and support for family caregivers. Other nations have prioritized planning for the aged. In China, elderly parents can sue their adult children for neglecting them. And Japan celebrates a national Respect For The Aged Day. Changing the perception of older people as frail and burdens to something that recognizes their wisdom and experience would be a good start.

5. We will learn that you really can’t fix stupid.

Many older workers never recovered from the Great Recession. They lost jobs and homes and saw the value in their retirement savings drop precipitously. While home prices and stock prices have recovered, some people couldn’t hang on long enough for the rebound. Some had to drain their savings for the future to pay for their living expenses. Those foreclosure and short sale stains on their credit still linger in some cases.

Basically, Washington’s position has been to simply treat these people like they don’t exist. They aren’t counted as unemployed because they don’t collect unemployment benefits any more. They fly under the radar: Instead of a full-time job with benefits, they’ve subsisted by stringing together a series of part time gigs to pay their bills. Their health plan ― at least until Obamacare came along ― was to plan not to get sick until they turned 65 and Medicare kicked in.

How did this happen? We let them know that their skills were obsolete yet didn’t offer to retrain them. We failed to support them when they were discriminated against in their jobs search. Instead we handed them the proverbial can opener when they said they saw cat food in their future.

According to the Department of Housing and Urban Development 31 percent of the nation’s ever-growing homeless population is over 50.

What will a new administration do for these folks? Probably make it illegal for them to sleep under the freeway.

What are YOU looking forward to in 2017? Let us know in comments.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 days ago.

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44% of US consumers want chatbots over humans for customer relations

December 8, 2016, 6:53 am

≫ Next: 5 Ways to Overcome Obstacles and Hurdles in your Startup

≪ Previous: 5 Things For Midlifers To (Sort Of) Look Forward To In 2017

44% of US consumers want chatbots over humans for customer relations

This story was delivered to BI Intelligence Apps and Platforms Briefing subscribers. To learn more and subscribe, please click here.

US consumers appear to be warming up to the idea of using of chatbots as a customer relationship management (CRM) tool, according to new research from Aspect Software Research.

In its online survey of more than 1,000 18- to 65-year-old US consumers, 44% said that if a company could get the experience right, they would prefer to use a chatbot or automated experience for CRM. That’s up four percentage points from the share of respondents who noted the same response in 2015.

Chatbots can best be thought of as software programs that use messaging as the interface to carry out various tasks for users. They're generally integrated into messaging apps to capitalize on these apps' vast reach and the conversational interaction they promote. In the context of CRM, chatbots can be used to ask about basic background information such as name, age, account numbers, as well as to ensure customers are directed to the appropriate channels, such as self-service or a human agent.

The technology could have the potential to help businesses significantly cut labor costs. While complete automation of the customer service workforce is not feasible, automating customer management and sales positions in the US where possible through chatbots and other automation technologies could result in considerable savings. For instance, 29% of customer service positions in the US could be automated through chatbots and other tech, according to Public Tableau. We estimate that this translates to $23 billion in savings from cutting annual salaries, not factoring in additional workforce costs like health insurance.

Nevertheless, businesses must ensure that the chatbot experience isn’t substandard, lest they risk alienating customers. Moreover, the automation service shouldn't be offered in isolation, but be able to seamlessly be picked up by a human agent, the study found. Eighty-eight percent of respondents expect their chatbot interactions to follow them through their transfer to a live person.

Advancements in artificial intelligence, coupled with the proliferation of messaging apps, are fueling the development of chatbots — software programs that use messaging as the interface through which to carry out any number of tasks, from scheduling a meeting, to reporting weather, to helping users buy a pair of shoes.

Foreseeing immense potential, businesses are starting to invest heavily in the burgeoning bot economy. A number of brands and publishers have already deployed bots on messaging and collaboration channels, including HP, 1-800-Flowers, and CNN. While the bot revolution is still in the early phase, many believe 2016 will be the year these conversational interactions take off.

Laurie Beaver, research associate for BI Intelligence, Business Insider's premium research service, has compiled a detailed report on chatbots that explores the growing and disruptive bot landscape by investigating what bots are, how businesses are leveraging them, and where they will have the biggest impact.

The report outlines the burgeoning bot ecosystem by segment, looks at companies that offer bot-enabling technology, distribution channels, and some of the key third-party bots already on offer. The report also forecasts the potential annual savings that businesses could realize if chatbots replace some of their customer service and sales reps. Finally, it compares the potential of chatbot monetization on a platform like Facebook Messenger against the iOS App Store and Google Play store.

Here are some of the key takeaways:

· AI has reached a stage in which chatbots can have increasingly engaging and human conversations, allowing businesses to leverage the inexpensive and wide-reaching technology to engage with more consumers.
· Chatbots are particularly well suited for mobile — perhaps more so than apps. Messaging is at the heart of the mobile experience, as the rapid adoption of chat apps demonstrates.
· The chatbot ecosystem is already robust, encompassing many different third-party chat bots, native bots, distribution channels, and enabling technology companies.
· Chatbots could be lucrative for messaging apps and the developers who build bots for these platforms, similar to how app stores have developed into moneymaking ecosystems.

In full, the report:

· Breaks down the pros and cons of chatbots.
· Explains the different ways businesses can access, utilize, and distribute content via chatbots.
· Forecasts the potential impact chatbots could have for businesses.
· Looks at the potential barriers that could limit the growth, adoption, and use of chatbots.

To get your copy of this invaluable guide, choose one of these options:

1. Subscribe to an ALL-ACCESS Membership with BI Intelligence and gain immediate access to this report AND over 100 other expertly researched deep-dive reports, subscriptions to all of our daily newsletters, and much more. >> *START A MEMBERSHIP*
2. Purchase the report and download it immediately from our research store. >> *BUY THE REPORT*

The choice is yours. But however you decide to acquire this report, you’ve given yourself a powerful advantage in your understanding of chatbots.

Join the conversation about this story » Reported by Business Insider 2 days ago.

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5 Ways to Overcome Obstacles and Hurdles in your Startup

December 8, 2016, 8:16 am

≫ Next: Evergreen Health suspended from individual insurance market

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Both startup founders and employees should be familiar with overcoming adversity. The startup life is a never-ending battle of establishing yourself as a new player in a market. The battle starts with being able to clearly and succinctly describe your product or service. You have to capture the attention of co- founders, teams, vendors, customers, industry to gain success in today's busy society. Quickly state your value proposition, hold the fluff. No one cares about your idea. No one cares that you want to save the world. People only truly care about what's in it for them.

As if trying to cut through the noise to have your voice heard is not hard enough, entrepreneurs and business owners also have to navigate the feeling of never having enough money. The revenue coming in feels like it can barely cover the expense of the myriad of services new businesses need. Floundering founders may unintentionally do things that are unproductive, or worse not focus on sales. Empowered business owners focus on mastering their pitch and supporting their arguments with detailed facts. This provides confidence to execute with focus. It is this focused execution that allows successful startups to last beyond the 4 year mark. are five ways to overcome obstacles and hurdles in your startup

*Create brand guidelines before launching*

Some of the most popular brands have one attribute in common. They are consistent. Their professional personas encompass the quality of their work, their presentation, and their consistency. So to, customers want to rely and trust your startup. Knowing that your business is capable of delivering a high quality product every time is integral to brand perception and staying in business for the long term. An easy strategy for projecting a professional and consistent brand is to create brand guidelines before launching.

Brand guidelines serve as your visual rulebook. If you haven't done this previously, no worries! Think about the feeling and emotions you want to convey with your brand and select elements of a brand that resonate with that image. Consider if you want your brand to be thought of as sleek and sophisticated or whimsical and playful. In the first case you may want to use black text with slim white font. In the latter example, using primary colors may resonate better with your target audience. It may be helpful to draw inspiration from iconic brands who deliver a vibe that is similar to what you want to create.

To round out your vision, you may want a logo or graphic designed. Open source platforms such as Canva allow you to become a graphic designer with zero experience! The platform is useful for creating the business basics such as business cards, logos and marketing presentations. Finally, services such a Vistaprint make quality low cost printing accessible.

*Thoroughly do your research*

Transforming data into actionable insights is powerful. Potential investors and partners will want to understand market size and revenue potential. Small markets don't make good investments for venture capital. Understanding your total available market allows you to understand market size. CB Insights a robust resource for acquiring data and market information. You want to determine how many potential customers exist within your niche, a reasonable price point and the total potential revenue that could be generated by addressing that marketplace need.An example:

There are estimated 22 million landlords in the United States.

If I am able to sell them each my software for $100 each, I have the potential to make $ 2.2 BillionResearch is also important to flesh out a business model and understand product market fit. This means you should be collecting primary data. Simply put, talk to your customers frequently and survey them to find out their pains and needs. The benefit of this work is that it allows you to create a buyer persona. This is a model of your target customer that includes unique identifying factors such as age, location, income, hobbies, worries, and habits. Done well, this persona allows you to speak your customer's language and address their needs effectively. ESRI's market tapestry is an excellent resource to start developing your buyer's persona.

Have you ever wondered how the brands you love are able to resonate with you so clearly? Maybe you've wondered how McDonalds or Target selects a new site location. Well, it's all strategic of course! These business decisions are largely influenced by local insights and economic indicators. Market research empowers business decisions. Although your business can be national or international, think locally for a moment. What zip code in your town or city do you believe your product or service can thrive in? Now use this zip code to research the demographics and lifestyle of these residents. This will help you identify key traits and characteristics that will help you find similar people in other locations.

*Develop processes and systems in advance*

Startup founders usually have trouble delegating responsibilities to others and on-boarding new talent. While we all understand that your business is your baby, a company cannot thrive when one person is the linchpin for all the work that has to get done. In short this internal struggle is attributed to lack of strategic planning and systems building.

Sounds simple, but the practice of implementing is much harder. I was lucky enough to read E-myth Revisited 3 years after I started my company. A close friend and successful entrepreneur suggested I give it a read after I confided in him with some issues I was having in my business. Now I recommend it as the first step someone should complete before taking the leap into entrepreneurship. This book will save you time, headache and help you set yourself up for success. Most people don't fully understand the dynamics of what it means to transition from an employee (technician) to entrepreneur/business owner. This book will get you there as painlessly as possible.

This book is fundamental to changing your mindset and put your emotions aside in favor of owning a system instead of creating a job for yourself. If you've read The Cashflow Quadrant, you understand the importance of owning a system. Take it to the next level with the E-myth. It's all about stepping up processes from the beginning. This simply means to document the steps and activities that allow you to be successful in the company.

* Focus on selling your MVP*

"Traction gives you credibility. Credibility gets you meetings. Meetings are where the magic happens." Paul Singh - Former Partner 500 Startups

There is a saying in the startup community which states, if you are not embarrassed by your MVP, you waited too long to ship it! This is absolutely true. I'm not advocating for being unprofessional, however I am saying you should capture the fundamental essence of what you are trying to accomplish and build out the most basic version of your product or service that people are willing to pay for. That threshold is likely a lot lower than you think.

*Cover your bases (backside...)*

Imagine only paying $30 -$50 per month for your own personal lawyer. A world-renowned one that is at your service to answer any questions you have and provide council on moves you are thinking of making - too good to be true? That is what prepaid legal services offers you! Think of it like you would a health insurance plan, only with legal services. You are paying a monthly premium for access to service should you need it. The idea is that the monthly fee subsidizes the true cost of the service. With one phone call, your lawyer provide consultation for you, review documents, make calls, send emails, write letter for your company and in some cases trial defense. Just like a health insurance plan, should you require services outside of the normal level, you simply pay the difference for another above your "allotment".

According to the American Bar Association, "group and Prepaid Legal Services plans provide an efficient mechanism for matching clients in need of services with lawyers. Group Legal Plans create panels of lawyers with expertise in various areas and match them with plan members/clients."

LegalShield founded in 1972 is an examples of prepaid legal services with a network of more than 6,900 independent provider attorneys across the U.S. and Canada. LegalShield has over 1.5 million members already.

Another household name is LegalZoom which has been around for 15 years. Of course, do your research to determine if the service is right for you.

It's easy to make excuses as new entrepreneurs and startups. Being proactive and resourceful are to key skill sets. Failure is not bad but necessary. Not pivoting is bad!

5 Ways to Overcome Obstacles and Hurdles in your Startup was originally published on Due by John Delia.

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 days ago.

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Evergreen Health suspended from individual insurance market

December 8, 2016, 9:34 am

≫ Next: Nearly 30 million Americans could lose their health insurance if the GOP rips up Obamacare

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Evergreen Health Cooperative will not be able to participate in the individual health insurance market in January and about 9,000 people already insured with the carrier have to find new plans by Dec. 15. The insurer has been attempting to convert to for-profit status since October after experiencing extreme financial stress earlier this year. As the company makes the conversion, the federal Centers for Medicare and Medicaid Services, which regulates business on insurance exchanges under the Affordable… Reported by bizjournals 2 days ago.

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Nearly 30 million Americans could lose their health insurance if the GOP rips up Obamacare

December 8, 2016, 10:14 am

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Nearly 30 million Americans could lose their health insurance if the GOP rips up Obamacare

For years, Republicans in Congress have been clamoring to repeal the Affordable Care Act (ACA), better known as Obamacare, President Barack Obama's signature legislative achievement.

With President-elect Donald Trump set to take office, the GOP may finally get its wish.

According to a new study, however, the repeal would come at a significant price, showing the tightrope the party could be forced to walk on to unravel the law.

The Urban Institute, a left-leaning think tank, analyzed the most likely proposal from Republicans for repeal of the law and found that millions of Americans could lose their insurance if it were to pass.

"We estimate that the partial ACA repeal would increase the number of uninsured people by 29.8 million by 2019, raising the total number of uninsured to 58.7 million people — 21 percent of the non-elderly population — compared with 28.9 million people uninsured if the ACA remains in effect," said the report, which was authored by Linda Blumberg, Matthew Buettgens, and John Holahan.

And the authors said the Republican repeal plan could hit certain groups of working-class families most.

"The vast majority of those becoming uninsured would be members of working families (82 percent), and more than half (56 percent) would be non-Hispanic whites," the study said. "The vast majority of adults becoming uninsured would lack college degrees (80 percent)."

Based on exit polling, many of these demographics that would be hit hardest by the repeal voted for Trump in the presidential election. According to exit poll data, non-Hispanic whites favored Trump by 20 percentage points, and non-college educated voters went for Trump by a 5-point margin. Non-college educated whites went for Trump by a 37-point margin.

Given the wide-ranging plans to repeal and replace Obamacare among Republicans — Trump, House Speaker Paul Ryan, and Secretary of Health and Human Services nominee Tom Price have all suggested or put forward differing plans — the researchers did have to make some assumptions.

They determined that the most likely scenario was a repeal from the budget reconciliation process. Since Republicans do not have a filibuster-proof majority in the Senate, they can likely only repeal those parts of the law that deal with the budget, such as Medicaid expansion and tax credits for exchange-based insurance.

Some GOP lawmakers have suggested they may pass a bill that would repeal Obamacare — but not until 2019. The Urban Institute used that time frame for its research.

The study estimated that spending by the federal government on healthcare would decrease by $109 billion in 2019 and $1.3 trillion form 2019 to 2028.

On the other hand, the medical losses due to uncovered Americans getting care at hospitals would also be significant. Blumberg, Buettgens, and Holahan noted that while uninsured people typically go in for care at a less-frequent rate, they do sometimes end up at the hospital or doctor.

These costs would be spread out between the federal government, local governments, and private healthcare providers. In total, the report estimated total cost for uncompensated care would total $57 billion in 2019 and $656 billion over 10 years.

A bill that passed Congress to repeal Obamacare in 2016 — which was vetoed by Obama — did not have an increase for federal spending on uncompensated care. In that case, more of the burden would fall on local governments and private healthcare providers, according to the Urban Institute.

If Republicans repeal Obamacare immediately, according to the study, the changes would come even more swiftly. an immediate repeal would cause insurers to lose nearly $3 billion for the year as people would likely stop paying premiums as they lose tax credits. Additionally, the number of uninsured would jump by 4.3 million almost overnight.

In order to mitigate these circumstances, Congress would have to take significant steps and pass a replacement bill.

"To replace the ACA after reconciliation with new policies designed to increase insurance coverage, the federal government would have to raise new taxes, substantially cut spending, or increase the deficit," the researchers concluded.

*SEE ALSO: Healthcare spending in the US just did something that rarely happens outside a recession*

Join the conversation about this story »

NOW WATCH: 'That hypocrisy is also real' — Jon Stewart takes liberals to task for calling all Trump supporters racist Reported by Business Insider 2 days ago.

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Disappointed By The AMA, Doctors Start A New Organization To Fight Trump's Health Care Policies

December 8, 2016, 1:02 pm

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President-elect Donald Trump campaigned on repealing and replacing the Affordable Care Act, so it’s not a huge shock that he picked Rep. Dr. Tom Price (R-GA), a former orthopedic surgeon and fervent ACA opponent, to head up the U.S. Department of Health and Human Services.

More surprising was the American Medical Association’s strong endorsement of Price in a statement from board of trustees chair Dr. Patrice Harris, who urged the Senate to “promptly consider and confirm Dr. Price for this important role.”

Backlash from physicians was swift. Among those who spoke out were Drs. Manik Chhabra, Navin Vij and Jane Zhu of the University of Pennsylvania, who wrote a post on Medium titled, “The AMA Does Not Speak for Us.” The trio challenged the association’s endorsement in their letter and invited fellow physicians to sign on.

As of Thursday, more than 5,000 health care providers have done so.

“The AMA represents approximately a quarter of physicians in the U.S. ― a loud, but minority voice,” the doctors wrote. “It certainly does not speak for us.”

Indeed, the American Medical Association’s inclusive-sounding name doesn’t mean it represents the opinions or will of all or even most doctors. As of 2012, the AMA represented about 26 percent of doctors, according to Modern Healthcare. Although he didn’t provide a more current percentage, spokesman Jack Deutsch told HuffPost the AMA is “the nation’s largest physician organization with a quarter of a million members.”

Chhabra, Vij and Zhu are part of the Clinician Action Network, a nascent alternative organization that has grown in response to Trump’s election. And their letter struck a cord. Before its publication, the initial group of CAN members included 60 health care providers. Network membership has since swelled to several hundred individuals, including physicians, nurse practitioners, physician assistants, pharmacists, social workers and community members.

While conversation about health policy is nothing new for many health care providers, the new group emphasizes activism in a novel way, according to Chhabra.

“They’re not folks who have previously been in roles as public advocates,” he said. “A lot of us became really scared [after the election] that suddenly the progress we’ve been seeing for the quality of care that our patients are receiving was ruined for us.”

Advocating for the most vulnerable patients through policy

The three doctors stressed that CAN is about promoting policies that improve patients’ lives, not becoming an arm of the Democratic or Republican parties.

“When someone becomes sick in this country, whether they’re rich or poor, we want to ensure that we have a system that’s able to take care of them in a particular way,” Chhabra said. “We don’t think that that’s a partisan thing.”

Instead, the group sees its role as a clearinghouse to connect clinicians to organizations that are already doing good work, and to coordinate support for patient-first, evidence-based health policies. They hope members will take a more public role in policy by writing op-eds for the public, policy briefs and background pieces to voice physician concerns.

“We’re going to be very responsive to legislation that is being introduced and voted on in Congress, both at the state level and the national level,” Zhu said. “This is the time for clinicians to take part actively in a process that’s always been dominated by politicians.”

What Price’s HHS tenure might look like

The group will have its work cut out for them.

Should Price be approved, he’ll enter the Trump administration with a detailed 242-page proposal to repeal and replace the Affordable Care Act, much of it targeted at reducing costs for the young and healthy at the expense of programs intended for the sick and poor. Included in Price’s proposal: a full repeal of Medicaid expansion and less help for patients with pre-existing conditions. And, unlike the ACA, Price’s proposed plan doesn’t require employers to cover addiction treatment, birth control, maternity care or prescription drugs.

The doctors pushed back on these policy changes in their letter:

We support patient choice. But Dr. Price’s proposed policies threaten to harm our most vulnerable patients and limit their access to healthcare. We cannot support the dismantling of Medicaid, which has helped 15 million Americans gain health coverage since 2014. We oppose Dr. Price’s proposals to reduce funding for the Children’s Health Insurance Program, a critical mechanism by which poor children access preventative care. We wish to protect essential health benefits like treatment for opioid use disorder, prenatal care, and access to contraception.

When asked about the criticism, the AMA pointed to a follow-up letter Harris posted Dec. 1, stating that Price’s physician background (Price is an AMA member) would provide important perspective within Trump’s cabinet. The organization said it has disagreed with Price on certain policy issues during his tenure in Congress, including his stance on the ACA. But the endorsement stands.

For the newly formed Clinician Action Network, that message was hard to stomach.

“We should judge a physician based on his polices and not give him a free pass just because he’s a doctor,” Zhu said. “Where he wants to take the direction of the health care system is important to the people who are practicing in it and the people who get served by it.”

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 days ago.

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Helping Gamers Get Health Care Coverage (An Epic Win)

December 8, 2016, 1:30 pm

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You heard it from Shaq himself: on Monday, December 12, the White House will host a competitive gaming event to help people sign up for health care coverage at HealthCare.gov. Tune in to twitch.tv/GetCovered to join in!

Millions of Americans participate in eSports (that’s Electronic Sports, or competitive video games) to connect with friends, to challenge themselves, to root for their favorite eSports team, and to be part of a rapidly growing community. In fact, more people now watch major eSports competitions than the number of people who watch the NBA finals or World Series.

As eSports grow in popularity and become increasingly mainstream, gamers are increasing in numbers and diversity. About 77 percent of men between ages 18-29 say that they play games, and so do 57 percent of women in the same age group.

Thanks to the Affordable Care Act, 20 million Americans now know the peace of mind and financial security of having health insurance. Young adults had the highest uninsured rates before the Affordable Care Act and have seen the sharpest drop in uninsured rates since 2010. But millions of millennials remain uninsured, and many of those uninsured young adults could qualify for tax credits on the Health Insurance Marketplace to keep insurance affordable. In fact, most HealthCare.gov consumers can find a plan for under $75 a month, less than their cell phone bill.

Gamers, like everyone, deserve high-quality health care coverage. Engaging the expanding gamer community is part of the Administration’s effort to meet people where they are to help them find a health care plan that’s best for them. That’s why last year, many from the eSports industry, including ESL, Twitch.tv and GEER, helped launch an initiative to encourage more gamers to sign up for health care at HealthCare.gov. And this year, HHS has forged innovative partnerships with digital platforms to help young adults understand that quality, affordable health care is within reach.

I know the power of video games first hand, and how incredible the gaming community can be. In high school, I had severe health challenges that led to hospitalization (and fortunately my care was covered as a dependent under my parent’s plan). During my recovery after the hospital, I helped lead a guild in the popular multiplayer online game World of Warcraft. Playing the game was empowering; it gave me a community where I could be myself, and I met players who became lasting friends, like Aceris the Druid, who’s also a librarian in Boston, or Chyra the Healer, who’s also a Maker in Michigan.

And we also absolutely rekt (humiliatingly defeated) our opponents in PvP (Player versus Player). The competitions brought us together, helped make our group a family, and made us part of a community. We looked out for each other. Gamers have other gamers’ backs FTW (For the Win).

So join us and members of the gaming community for a live-streamed event at twitch.tv/GetCovered on Monday, December 12, and help your fellow gamers #GetCovered at HealthCare.gov.

Erik Martin is a Policy Advisor for the White House Office of Science and Technology Policy. Reported by The White House 2 days ago.

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December 3 Stories About Optima Health - supporting our mission to improve health everyday

December 8, 2016, 1:23 pm

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Dec 15 deadline approaching to enroll in highly rated Optima Health Individual and Family health plans with an effective date of Jan 1. Optima Family Care sponsoring and participating in local toy drive and parade on Dec 10.

Virginia Beach, VA (PRWEB) December 08, 2016

December 15 Last Chance to Enroll in Individual and Family Health Coverage for January 1 Effective Date

Open Enrollment for 2017 Individual and Family health plans is currently ongoing until January 31, 2017, however, for plans to be effective January 1, 2017, the deadline to enroll is December 15, 2016. These plans are available for anyone in Virginia who doesn’t have health insurance through a job, Medicare or Medicaid.

OptimaFit® Individual and Family health plans can be purchased directly through Optima Health, or through the government Marketplace. For its fourth year, Optima Health is offering a variety of OptimaFit® plans to fit different budgets, lifestyles and healthcare needs. Government tax credits may also be available for individuals and families with income below certain levels, when plans are purchased through the Marketplace.

Individuals and families are encouraged to learn more about OptimaFit® plans, which recently received Virginia’s highest CMS quality rating, 4 out of 5 Stars.[1] In addition to making positive strides towards better health, making a decision to purchase health insurance will eliminate the government requirement to pay a fee for not having health insurance.

Optima Health Sponsors Christmas Toy Drive and Parade in Norfolk

On Saturday, December 10th, volunteers from Optima Health will take part in the annual Ricky Johnson and Friends Foundation Christmas for Kids Parade, on behalf of the Optima Family Care Medicaid product. This will be the seventh year Optima Health has supported the event, through sponsorship, volunteering and collecting toys, as part of its steadfast commitment to giving back in the communities where it serves.

2016 marks the 10th year of the Ricky Johnson and Friends Foundation Christmas for Kids Parade, and the first year it will take place in Norfolk. With its roots in Richmond, the event has expanded over the past two years to the Petersburg and Norfolk, Virginia areas to surprise children in local communities with toys for Christmas.

Optima Health Celebrates Quality Ratings for Medicare, Marketplace and Commercial Plans

The results are in from our country’s leaders in health care quality improvement – the Centers for Medicare and Medicaid Services (CMS) and the National Committee for Quality Assurance (NCQA) – and Virginia-based Optima Health has achieved high ratings across the board for its Medicare, Marketplace and Commercial plans, as follows:·     Medicare Advantage Prescription Drug plans- 4.5 out of 5 CMS Star Rating[2]
·     Marketplace HMO health plans- 4 out of 5 CMS Star Rating
·     Commercial HMO/POS health plans- 4 out of 5 NCQA rating[3]

For 18 consecutive years, Optima Health has also achieved NCQA accreditation for its commercial HMO/POS health plans and Medicaid HMO product; and since 2013, for its Marketplace HMO health plans.[4]

About Optima Health

Optima Health, based in Virginia, provides health insurance coverage to approximately 450,000 members. With 30 years of experience in the health insurance arena, Optima Health offers a suite of commercial products including consumer-directed, employee-owned and employer-sponsored plans, individual health plans, employee assistance programs and plans serving Medicare and Medicaid enrollees. Its provider network features 26,000 providers including specialists, primary care physicians and hospitals across Virginia. Optima Health also offers programs to support members with chronic illnesses, customized wellness programs and integrated clinical and behavioral health services, as well as pharmacy management – all to help members improve their health. The company’s goals are to provide better health, be easy to use and offer services that are a great value. To learn more about Optima Health, visit http://www.optimahealth.com.[5]

[1] CMS rates qualified health plans (QHPs) offered through the Marketplaces using the Quality Rating System (QRS), which is based on third-party validated clinical measure data and QHP Enrollee Survey response data. CMS calculates QRS ratings annually using a 5-star scale. QHP issuers contract with HHS-approved survey vendors that independently conduct the QHP Enrollee Survey each year. QRS ratings and QHP Enrollee Survey results may change from one year to the next. For more information, please see CMS’ Health Insurance MarketplaceSM Quality Initiatives website at: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/QualityInitiativesGenInfo/Health-Insurance-Marketplace-Quality-Initiatives.html.

[2] Optima Medicare is an HMO with a Medicare contract. Enrollment in Optima Medicare HMO is dependent upon contract renewal. Medicare evaluates plans based on a 5-Star Rating system. Star Ratings are calculated each year and may change from one year to the next.

[3] (NCQA) Private Health Insurance Plan Ratings 2016-2017 (http://healthinsuranceratings.ncqa.org/2016/search/Commercial/VA).

[4] NCQA Accreditation Letters, 1998-2016.

[5] The membership figure includes total membership in all group and individual insured products, Medicare Managed Care Plans, Medicaid and Famis Plans, and self-funded health plans issued or administered by Optima Health. Total Medical Membership based on Membership History Report, June 2016. Includes members from all Optima Health Licenses, products, Medicare and Medicaid products. Optima Health is the trade name of Optima Health Plan, Optima Health Insurance Company, and Sentara Health Plans, Inc. Optima PPO plans, and Medicare Managed Care Plans are underwritten or administered by Optima Health Insurance Company. Optima Vantage HMO plans, Medicaid, and Famis products are underwritten or administered by Optima Health Plan. Sentara Health Plans provides administrative services to self-funded plans but does not underwrite benefits. Employee Assistance Programs (EAP) are administered by Optima Behavioral Health Services, Inc. Wellness programs are administered by Sentara Health Plans. Source for provider network is Optima Health, Provider Status Report, February 2016. Reported by PRWeb 2 days ago.

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AG Healey says she'll sue if needed to protect the state's health care market

December 8, 2016, 1:43 pm

≫ Next: Beware Compounded Drugs -- Especially Under Trump’s FDA

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Attorney General Maura Healey is prepared to protect the Massachusetts health insurance market from upheaval, even if it means suing the federal government. Healey talked about her approach during a discussion of the Affordable Care Act, also referred to as Obamacare, at the Boston Business Journal offices. She said her office has an interest in making sure that people had continued access to health insurance. While Massachusetts health care reform would stay in place even if Obamacare is repealed,… Reported by bizjournals 2 days ago.

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Beware Compounded Drugs -- Especially Under Trump’s FDA

December 9, 2016, 4:33 am

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President-elect Donald Trump has pledged to eliminate 70 to 80 percent of all federal regulations, and the Food and Drug Administration’s (FDA) rulebook is near the top of his list. Close Trump adviser Newt Gingrich has denounced the FDA as the nation’s leading “job killer,” and has called the agency “a major prison guard stopping the breakout in health.”

If the Trump administration makes good on these threats, an already weakened FDA could approach paralysis, exposing millions of patients to unsafe medications. Particularly at risk will be those who receive ostensibly “sterile” injections for back and neck pain, among other ailments, from compounding pharmacies. Essentially small businesses with overweening national ambitions, compounders were implicated in a deadly meningitis outbreak in 2012, and continue to manufacture potentially dangerous drugs administered to millions of Americans. Federal prosecutors have accused them of defrauding government health-care programs of hundreds of millions of dollars. The Obama administration failed to get a solid grip on regulating the industry, even when serious quality control problems emerged, and the Trump administration is likely to turn its back on the problem entirely, setting the stage for another fatal outbreak.

How did local businesses finagle their way into selling tens of thousands of doses of medicine made in small facilities that often fail to meet rudimentary safety standards? And why have Congress and federal regulators done nothing to stop it? The story is a troubling one that grew out of the epic pressures on modern health-care costs that began well before this election. The protagonists are an industry that has grown ever greedier, dysfunctional federal and state regulators, and a Congress that passed a law it should have known would not work.

A public health catastrophe made the problems with compounding pharmacies headline news in 2012, when a virulent outbreak of fungal meningitis was traced back to the New England Compounding Center (NECC) in Framingham, Massachusetts. The NECC shipped 17,676 vials of contaminated methylprednisolone to health-care facilities in 20 states. Injections were administered to 14,000 patients, killing 64 and severely sickening 753. Fungal meningitis develops one to four weeks after exposure, and produces inflammation of the brain or central nervous system. Even if the disease doesn’t kill the patient, it can persist for years.

Compounding, defined as the mixing of drug doses tailored to the individual patient, has existed as long as people have made medicine. Up until recently, American compounders worked at the local level. In the early 1990s, hospitals eager to avoid the headaches of making compounded drugs in-house turned to these independent pharmacies, dramatically expanding their customer base. The most entrepreneurial among them saw the opportunity to also expand their boundaries, mixing and selling large quantities of medicine across state lines without individual prescriptions. The NECC was able to get licenses to sell medicine in 44 states. A former manager who spoke on the condition of anonymity told The New York Times: “It was a license to print money. I’ve never seen a business grow so fast.”

The NECC produced the tainted injections in a so-called “clean room” that was actually startling in its squalor. The air conditioning was turned off at night; equipment was rusted; swabs showing contamination of work surfaces were ignored; and test tubes sprouted visible black growths floating in otherwise transparent liquid. As federal and state regulators converged on the facility, the family members who owned the NECC and its sister company, Ameridose, surrendered their pharmacy licenses and shut down.

In December 2014, federal prosecutors indicted 14 NECC employees; the two most senior members of the group face second-degree murder charges applied through the Racketeer Influenced Corrupt Organizations Act. The case has yet to go to trial, although The Boston Globe reports that proceedings may start in January 2017.

Gage Skidmore/Creative Commons

Close Trump adviser Newt Gingrich has denounced the FDA as the nation’s leading “job killer,” and has called the agency “a major prison guard stopping the breakout in health.”

*COMPOUNDING SOLVES SEVERAL MEDICAL *and economic problems. Some patients are allergic to components of mass-produced products and need special mixtures that omit these ingredients. Children and the elderly may need doses of medicine not found in standardized products. Drug shortages can drive health care providers to compounding pharmacies that provide substitutes. Last but by no means least, compounders price their products low enough to undercut the costs of standardized medicines sold by the major drug companies.

The International Academy of Compounding Pharmacists, an industry trade association, estimates that 3,000 firms produce sterile preparations. Sales have grown by leaps and bounds. According to a report by the Health and Human Services Department’s Office of the Inspector General, between 2006-2015, Medicare expenditures grew by 333 percent for compounded intravenous drugs, and by 285 percent for compounded injectable drugs. The NECC outbreak and its aftermath had very little effect on these developments.

Because the industry is dominated by under-regulated small businesses that grew very rapidly, fraud was almost inevitable. Federal prosecutors have indicted 25 defendants for selling unnecessary compounded medications to TRICARE, the health insurance program that serves 9.4 million military service members. TRICARE experienced a “massive surge” in claims for “unnecessary and costly compound drugs” in 2014 and the first half of 2015, with costs eventually reaching more than $1 billion in just the first four months of 2015. Compounded drugs accounted for only 0.5 percent of the volume of medications supported by the program, but totaled 20 percent of total costs. In May 2015, when TRICARE implemented stricter screening to ensure that all the drugs it pays for are safe and effective, the monthly total dropped precipitously to $10 million.

No publicly funded health-care system can afford such rip-offs. But the problem with compounders is not just that they squander money. The 2012 NECC outbreak uncovered widespread quality control problems that cried out for a national crackdown that never took place.

At first, despite severe funding gaps, the FDA appeared poised to act. The agency selected 31 facilities across the country for “risk-based” audits based on adverse event reporting by health care professionals and historical inspection data. Inspectors discovered safety problems at 30 of the 31 facilities, including “inappropriate or inadequate, or both, clothing for sterile processing, lack of appropriate air filtration systems, insufficient microbiological testing, and other practices that create risk of contamination.” The FDA sent “warning letters” to 18 of these compounders. Such letters explain what a company is doing wrong but only threaten future legal action.

Then Congress got involved. Despite low approval ratings and a well-deserved reputation for gridlock, Congress has a history of passing landmark legislation in the aftermath of national emergencies. The 1970 Clean Air Act responded to reporting on blankets of thick smog over Rust Belt cities. The Clean Water Act passed in 1972 after the Cuyahoga River caught fire. When a sulfa “wonder drug” containing anti-freeze killed 100 people in 1937, many of them children, Congress produced the Food, Drug, and Cosmetics Act. And in November 2013, Congress sent the Drug Quality and Security Act (DQSA) to President Obama’s desk.

Unfortunately, the bill was a bipartisan compromise that further undermined FDA enforcement. When Congress began the debate, it seemed to be heading in the direction of traditional reforms, including tougher penalties, stronger safety rules, and more vigilant FDA oversight.

AP Photo/Bill Sikes, File

A Food and Drug Administration agent stands at the doorway of New England Compounding Center (NECC) in Framingham, Massachusetts, after a virulent form of fungal menigitis was traced back to the NECC in 2012.

But relatively late in the game, following a high-dollar lobbying campaign by the compounding pharmacy industry, a peculiar compromise emerged. The new law allowed the owners and operators of compounding pharmacies to decide whether or not their businesses meet the new law’s definition of an “outsourcing facility” that should pay to register with the FDA. If a company decides not to turn itself in, the FDA could prosecute it for dispensing medications without a prescription written by a doctor for a specific patient. But if the company never registers and violates the law by selling compounded drugs across state lines without prescriptions, the FDA confronts a catch 22: it cannot chase violators it has not identified.

*THE **RATIONALE OFFERED** FOR THIS* compromise was that the market could take care of the problem. Health-care facilities would insist that the compounders who provided their sterile medications were registered and under FDA oversight. This assumption was fatally flawed. Today, three years after the law’s enactment, about 66 facilities—or about 2 percent—have registered out of the 3,000 compounders estimated to be making sterile drugs. This registration number has fluctuated at the margins, with a few compounders de-listing themselves and a handful joining the list for the first time each year.

The bottom line is that if the FDA happens to discover problems at any of the 2,900 remaining pharmacies, these facilities could be subject to sporadic enforcement. But in the absence of registration and the resources to inspect every pharmacy on a regular basis, the FDA must depend on whistle-blowers, physician reports of adverse incidents, or customer complaints to identify problems.

Quality control problems persist. Of the 66 pharmacies that are now registered with the agency voluntarily, 52 have been notified of potential violations spotted during compliance inspections. Thirteen of the remaining 14 compounders have not yet been inspected, meaning that only one of the registered firms has managed to pass inspection without sending up any red flags. In 2015, the most recent year for which data are available, the FDA inspected 215 pharmacies, up from 92 in 2014, but still only 10 percent of the estimated total.

The FDA has been inordinately hesitant to bring violators to court. Between October 2012 and August 2016, FDA enforcement staff brought only four cases, winning permanent injunctions against violations in each case. Three additional firms, including NECC, face criminal charges.

Donald Trump has pledged to eliminate 70 to 80 percent of all federal regulations, and the Food and Drug Administration’s (FDA) rulebook is near the top of his list.

The FDA’s curtailed role leaves state pharmacy boards on the front lines of oversight for this burgeoning industry. The boards are composed of pharmacists serving part-time who are assisted by small staffs. Their primary purpose is to license individual applicants, not to inspect pharmacies to verify safety measures. Even in a state with a reputation for progressive oversight like Massachusetts, this set-up proved woefully inadequate.

Federal and state regulators were well aware of the NECC’s sanitation problems as early as 2002-2003, when inspectors visited the facility repeatedly. They developed a list of serious violations that needed to be fixed. But FDA regulators withdrew from a formal role in the case, ceding responsibility for follow-up to the state board. That board required the NECC to hire a third-party auditor to furnish a detailed report of the steps needed to make the “clean” room safe. The audit team discovered the same problems as the regulators had, but nevertheless recommended that the board take the NECC off probationary status. The board approved this faint slap on the wrist in 2006.

In February 2016, the Pew Charitable Trusts released a report on state oversight of compounding pharmacies that revealed dangerous gaps in the states’ performance. Only half of the 43 states that responded to the Pew survey required compounders to conform to widely recognized quality control standards established by the U.S. Pharmacopeial Convention. The majority (26 of 43) did not require pharmacies to report serious adverse events associated with sterile compounding. Twenty-eight of the 43 states that responded to Pew allow compounders to manufacture compounded medicines without patient-specific prescriptions.

The Obama administration has always supported the FDA’s mission, and appointed highly qualified commissioners to lead the agency. But the president fell short when it came to defending the agency against harsh attacks by GOP critics on Capitol Hill, leaving the agency short of desperately needed additional funding. Given Trump’s vow to roll back government regulations and shift federal money to defense, federal oversight of compounders will probably be even less effective under the next administration.

In fact, President-elect Trump seems likely to appoint industry executives or conservative policy wonks to head agencies that protect public health, worker and consumer safety, and the environment. They are likely to low-ball operating budgets and discourage aggressive enforcement. Inevitably, the day will arrive, probably sooner than later, when contaminated compounded drugs cause another string of illness outbreaks and fatalities. But this time, Trump political appointees will be the ones sitting in the hot seat as bipartisan and irate members of Congress excoriate them.

Public health crises that result in the death of constituents have always been very bad news for presidents, regardless of which party controls Congress. Trump’s pledge to douse regulation is intended to mollify such business groups as the U.S. Chamber of Commerce and the National Association of Manufacturers, and they will undoubtedly applaud these initiatives. But, as Secretary of State Colin Powell once said of federal service, “you break it, you own it.” The government that president-elect Trump loves to hate will be his albatross when it fails to protect patients. Reported by The American Prospect 1 day ago.

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White Women, It's Time To Get A Clue ... If It's Not Too Late

December 8, 2016, 3:01 pm

≫ Next: The White House plans to use Twitch for raising health care awareness next week

≪ Previous: Beware Compounded Drugs -- Especially Under Trump’s FDA

*Not all white women are clueless. But Trump's victory proves that the majority of us are. *

I've never understood the election statistic that most married white women vote Republican. Even if they were Democrats before their wedding day, there's apparently something about putting on that ring that turns their blue hearts to red.

Yes, I'm a white woman, but a diehard liberal Democrat. So I cannot for the life of me understand why white women go Republican or why they would ever vote for Donald Trump. It's understandable, policies aside, that in 2012 many white women voters liked that nice Mitt Romney with his ever-growing brood and good head of hair. But how in the world did white women allow themselves to be bamboozled to vote against their own interests by the biggest misogynist since Rush Limbaugh?

I know the answer. Too many white women think that certain bad things will never happen to them, so they don't have to worry about them. Yes, Trump mocked Hillary Clinton mercilessly on the campaign trail. Yes, he constantly lied about her, saying that she was "crooked" without a shred of evidence (and ignoring the fact that he, himself, isn't the straightest arrow.) Yes, he let his alt-right supporters chant about locking her up, and worse. But those things would NEVER happen to nice white soccer moms, right?

That kind hubris and ignorance has now put the least qualified person to ever run for president into the Oval Office. And we have white ladies to thank for that. The women's vote has determined the presidential winner in every election since 1980, and Tuesday night, 53 percent of white women voted for Trump.

Too many white women take things for granted and assume that things many people complain about just don't happen to them. For example, many 21st century feminists have bought into the fairy tale that we now live in a world where qualified women don't experience sexism or discrimination. They blithely went along with white woman Sheryl Sandberg who convinced them that to advance in a world of men, all they had to do was "lean in" a little harder; that they should stop worrying their little heads about blatant misogyny because working harder and longer would make up for the male bosses who continue to promote less qualified men at their expense.

It also didn't help that many younger feminists said, "Nah, no need to vote for Hillary 100 years after suffrage, because I'm sure that I'll see a woman president in MY lifetime," while glibly casting their protest votes for Gary Johnson, arrogantly brushing off the dreams of the handful of 100+ -year-old women who were proudly voting for HRC in their white pantsuits, something they thought they would never live to see.

White girls, it's time to wake up. Because if you don't, soon your daughters are going to be in exactly the same spot you are today - living in a time where the leader of the free world is a lying, sexist, pussy-grabbing bigot who cares about no one other than himself and his own authoritarian style of self-aggrandizement.

Don't take my word for it. My white "sister" from the north of the border will school you:" [White voters], if Muslims have to take responsibility for every member of their community, then so do we. ... A majority of white women, when faced with the historic choice between the first female president and a vial of weaponized testosterone said, 'I'll take Option B. I just don't LIKE her.'"

No, white girls didn't like Hillary Clinton. I already knew that, but I didn't think they'd play that high school card with so much vigor that it would keep one of the most qualified candidates ever to run for the White House from taking the oath of office.

Women voters of color knew they didn't have to like Hillary (though many probably did) in order to vote for her. They knew they needed someone who was smart, qualified, and experienced who had the policy chops and connections to help everyone economically and who could make the world a safer place. But because the majority of white girls didn't "like" Hillary, they voted for the unqualified wrecking ball who will now have a GOP Congress to do his authoritarian bidding. Because white girls didn't like Hillary, we are all now stuck with the guy who has never held elective office who says his brain is so good he doesn't have to consult anyone on anything, even on military matters or "bombing the shit" out of people.

In 2020, white ladies, you might want to get over that likability fetish. The first woman president doesn't have to be like you, even though you apparently think she does. I know you hated the smart girl with glasses in high school who wanted to be on student council, go to college and make a difference in the world. Been there, done that. I'm also guessing that you seemed to like the guy in high school who paid the negative attention to you and you thought you could change him. Well, at least that's how Paul Ryan and Mitch McConnell view Trump. But you ladies who tried to be the good influence on the bad boy know that has zero chance of working.

The wheels are already turning to put the extreme policies of Donald Trump into effect - cutting Social Security and Medicare, getting rid of health insurance for the 20 million people who just started being able to see doctors again, and cozying up to other strongmen like Russia's Vladimir Putin and Palestinian president Mahmoud Abbas.

But it's not just the fault of the white women who voted for Trump. It's also the fault of the rest of us white women who weren't able to convince them of how dangerous it would be if Trump got the keys to the White House. For you white ladies who decided Trump was better than Hillary, I hope you enjoy the next four years as you realize that all the things Trump claimed he'd do for the "little guy" - like bringing back manufacturing jobs and helping the economy by trashing any and all trade agreements - will never happen, because he has never cared about you, and he isn't about to start now. Oh, and that paid maternity leave policy he claimed to be so interested in? In case you hadn't checked, there's no there there.

Take this to the bank - in 2020 you will be shaking your heads over how the once great United States turned into a virtual Trump dictatorship that has benefitted no one, other than Trump and his ego, and that has become dangerous for all of us. And that's when I'll sadly say, just look in the mirror and you'll see who bears the blame.

*Joanne Bamberger is the founder of the digital magazine of women's commentary The Broad Side and the author/editor of the the award-winning bestseller Love Her, Love Her Not: The Hillary Paradox.*

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 days ago.

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The White House plans to use Twitch for raising health care awareness next week

December 8, 2016, 3:26 pm

≫ Next: An Open Letter To President-Elect Trump

≪ Previous: White Women, It's Time To Get A Clue ... If It's Not Too Late

The White House plans to use Twitch for raising health care awareness next week

The White House teamed up with Twitch to throw an upcoming four-hour party on Monday to raise awareness about the importance of health insurance. The event will feature popular streamers, Rocket League, Street Fighter V, and more. Reported by Digital Trends 2 days ago.

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An Open Letter To President-Elect Trump

December 8, 2016, 3:48 pm

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An Open Letter to President-Elect Trump From Ron Garan, Col. USAF, (Ret)

Congratulations on your election victory. Thank you for your words of conciliation in the early morning hours following the election, and your "pledge to every citizen of our land that (you) will be president to all Americans."

You also reached out to people who did not support you to ask for guidance and help, "so that we can work together and unify our great country." I am one of those people.

As a citizen of this great nation, I respectfully offer guidance on immediate steps that can help start the process to bring everyone "together as one united people."

First, reconsider your promise to cancel every one of President Obama's executive orders and programs on your first day in office. As a businessman, and now as president-elect, you know orderly transitions matter.

Canceling the health insurance of millions of Americans without a fully functioning system to replace it will disrupt if not destroy the lives of those who depend on it.

Consult the science community as you plan. As a NASA astronaut who lived and worked in space, I know Earth is not flat, that we live in a highly interrelated and interdependent biosphere, that climate change is real. People so often speculate that if world leaders could see Earth from space like astronauts and cosmonauts do, everything would be different. I believe this is true. Please consider these thoughts from men and women who are among the few who have seen our planet from space.

http://j.mp/CallToEarth

Unilaterally pulling out of the agreements the United States made with other nations during the COP-21 Paris Climate Conference, puts America on a dangerous path threatening the future of the world. In the short-term, we will alienate the other signatories, and demonstrate that our words and promises mean nothing.

You said during your victory speech, "I want to tell the world community that while we'll always put America's interests first we will deal fairly with everyone, with everyone, all people and all other nations. We will seek common ground not hostility, partnership not conflict." I assure you that canceling America's commitment to the 2015 Paris Climate Conference will be seen by the world as an act of hostility and conflict.

I share with so many Americans a frustration with the present state of our government. I look forward to meaningful and real reform to our political system. In the meantime, I respectfully ask that you consider the views and needs of all Americans before following through on your promised immediate actions. Without a carefully considered plan that takes into account the long-term effects to our nation, and to the world, I am unable to see any path that brings us "together as one united people."

-- This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website. Reported by Huffington Post 2 days ago.

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