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Low-Income AIDS Patients Fear Coverage Gains May Slip Away

When Tami Haught was diagnosed with HIV, she was one day shy of her 25th birthday. The diagnosis did not come as a shock since doctors had determined her fiancé was dying of AIDS several weeks earlier.

In the two decades since, Haught, 48, has turned to expensive prescription drugs to keep the deadly infection in check. In 2005, she began receiving help purchasing her medications through the AIDS Drug Assistance Program (ADAP), a federally funded network of programs in each state that assist low-income HIV and AIDS patients. Since the Affordable Care Act was implemented, ADAP instead has helped her buy an insurance policy to cover a wide assortment of her health care needs.

Nationally, more than 139,000 clients were served by ADAPs in June 2015, according to the latest report from the National Alliance of State and Territorial AIDS Directors (NASTAD), a coalition of state officials responsible for administering HIV and hepatitis programs. About half of those clients were getting help purchasing insurance through the federal health law’s marketplaces or elsewhere, a switch from the program’s historical role of paying primarily for expensive prescriptions.

Advocates fear Republican plans to overhaul the health law could cause such upheaval in the individual insurance market that the program could not afford to continue the premium assistance and would be forced to turn primarily back to subsidizing medication.

“We are at a pivotal point in HIV where people are talking about the end of the epidemic,” said Ann Lefert, senior director of the prevention and care program and policy at NASTAD. “It’s hard to imagine that, if the health care coverage changes dramatically — it would be hard to get there in the same speed.”

According to the AIDS directors’ report, in June 2015, about 72,000 got help paying for their insurance, including nearly 4,000 who also received assistance to purchase medication. That’s more than twice as many as got insurance help in 2010, when the health law was passed.

[caption id="attachment_708219" align="alignright" width="270"] Tami Haught, who was infected with HIV 23 years ago, now gets help paying for her insurance through the AIDS Drug Assistance Program. She worries that changes in the health law could cut back that help. (Courtesy of Tami Haught)[/caption]

To qualify for ADAP assistance, prospective clients must meet standards determined by the state. Individuals must prove their residency and recertify every six months. NASTAD reported more than 70 percent of clients served by ADAP in June 2015 reached viral load suppression, or undetectable levels of HIV in the blood. By comparison, only 3 of 10 people living with HIV in the U.S. reached suppression in 2011, the Centers for Disease Control and Prevention reported.

ADAP is required to choose the most cost-effective way to assist clients. Currently, that option often is financial assistance for purchasing an insurance plan that covers broad health expenses. But before the ACA, when insurance companies could legally exclude customers with preexisting conditions or charge them very high premiums, buying insurance was difficult for HIV patients.

Consequently, the program focused primarily on helping patients buy the pricey drugs they needed. It struggled to meet that demand, however, often using waiting lists to determine which low-income clients could be helped. At its peak, 9,278 individuals waited to access ADAP services, according to NASTAD. The program eventually eliminated the waiting list in 2013.

For many of those low-income patients, it was the only help available, given they weren’t eligible in many states for Medicaid, which generally limited eligibility to children, very-low-income families and people with debilitating conditions.

“Most people had to be disabled in order to get access to Medicaid services, even though the treatments that became available in the 1990s prevented you from being disabled,” said Jeffrey Levi, a health management and policy professor at George Washington University in Washington, D.C.

But the ACA’s provisions — principally, the Medicaid expansion undertaken by 31 states and the District of Columbia; subsidies for low-income people buying plans on the insurance marketplace; and consumer insurance protections —enabled ADAP to spend less on purchasing drugs and use its funds more efficiently to help clients buy coverage. They could use the assistance to pay the portion of premiums not covered by federal tax subsidies and expenses not picked up by their plans, such as deductibles and copayments.

The NASTAD report also found that ADAP paid an average of $1,678 per client for medications in June 2015. In contrast, the program contributed an average $444 to health plans for clients. Some insured clients, however, also received help paying for medication.

While Lefert said she doesn’t anticipate waiting lists returning to ADAP if the health law is partially repealed, other experts worry about how far existing funds can be stretched.

“Now you’re going to have a bunch of people rushing back to the [ADAP] pool with not enough dollars to cover them all,” said Matthew Rose, policy and advocacy manager for the National Minority AIDS Council.

Changes to the health law could interrupt treatment and lead to gaps in care, said Erin Loubier, senior director for health and legal integration and payment innovation at the Whitman-Walker Health clinic in Washington, D.C. And without protections from discrimination based on preexisting conditions, she said, people could shirk screening for fear of losing their jobs or health insurance.

Haught, of Nashua, Iowa, now works as a training coordinator for the SERO Project, an advocacy group fighting against HIV criminalization laws around the nation. Haught said she’s surprised that she’s lived 23 years past her diagnosis, which allowed her to see her son graduate and spend time with her grandson, Chase. Taking her medication is critical.

“I will die if I don’t have access to my medication and treatment, and it’s not pretty,” she said. “I’ve seen it. It’s not an easy death.”

I Do … Take You To Be My Lawfully Covered Health Care Dependent

“This is a first for me,” said Rabbi Andy Dubin, as he sat down on a collapsible chair opposite Ann Justi and Don Boyer.

The trio was in the compact living room of Boyer’s apartment in Yonkers, N.Y., standing between the sofa, TV and writing desk. Dubin was in his socks, having shed his snow-caked boots in the hallway.

Boyer and Justi were getting married. Never mind the blizzard-like conditions that kept one set of friends home, and a bad cold that waylaid another. They were determined to tie the knot that afternoon. So they recruited their landlord from downstairs and a public radio reporter to be witnesses.

Why the rush? Boyer and Justi had been listening to the news. They were planning to get married in the fall, but it occurred to them that there’s no knowing what could happen to health insurance if the Trump administration and congressional Republicans dismantle the Affordable Care Act.

Justi has several preexisting conditions — osteoporosis, asthma, allergies and vitamin B-12 malabsorption — and the insurance she carried over from her previous job will expire this summer. She had employer-based insurance for more than a decade but was laid off last year.

Justi and Boyer knew they could wait until the spring to get married, and she then could go on the health plan he receives as a concierge for a residential building — it’s a union job, and the health insurance is good. But Boyer worries about Republicans unspooling crucial Obamacare safeguards.

“There’s so much uncertainty as far as what’s going to be law tomorrow, what’s going to be law next month,” he said. “Nobody really knows, unfortunately.”

Much of the focus in the “repeal and replace” debate has been on the 20 million Americans who have received coverage via state and federal health insurance exchanges and Medicaid expansion. But most Americans still get coverage from employers, and their plans now have protections that could also be rolled back.

Under the Affordable Care Act, private insurers can no longer reject people with preexisting conditions, or charge them more for their insurance. As of now, the GOP plan moving through Congress also would require that people with preexisting conditions be able to get health insurance.

But there are other factors that could make that insurance much more expensive — such as the applicant’s age and the lack of a mandate, under the GOP plan, that everyone have health insurance. If you get rid of the mandate, many health care analysts say, it’s likely that the people buying that insurance would mostly be sick — further driving up the cost of the insurance, and driving out of the insurance pool the healthy, younger people who tend to bring down the cost of the insurance.

Justi’s current situation of having temporary insurance with an expiration date — instead of being on a stable health plan that can’t kick her off — takes her back to an earlier, uglier time in her life.

“Before the Affordable Care Act, I went from one employer to another, and the new employer’s insurance didn’t cover my preexisting conditions for a year, and that nearly bankrupted me,” she said.

So Justi and Boyer decided to get legally married as soon as possible, and have a more ceremonial, celebratory wedding in the fall. They found Rabbi Dubin online, on a list of licensed local wedding officiants. They warmed to his profile, even though neither is Jewish.

The service in their living room proved relaxed but formal. Dubin wore a suit, and both bride and groom were fashionably attired in black. Boyer sported a white rose boutonnière. Justi held a bouquet of white roses and calla lilies, their stems wrapped in silk. Dubin talked about marriage and commitment and faith. And he nodded to their need to protect themselves.

“Every marriage is important — but it’s also important because you are living in times, as we all are, when sometimes we have to take things into our own hands to make sure we come out all right on the other side,” he said.

For about 20 minutes, they discussed the journey behind the couple and the one ahead. Boyer and Justi read vows they’d written to each other, and then gave each other rings. Dubin declared, “By the authority vested in me by the state of New York, I now pronounce you, Don and Ann, husband and wife.”

They kissed, then signed some paperwork, raised a toast of sparkling water, took some smartphone pictures and embraced the rabbi.

They were beaming like newlyweds — albeit very practical newlyweds who were already planning next steps.

“As quickly as possible, I want to get you and this form down to the union headquarters tomorrow,” Boyer said.

And that was it. The landlord headed back downstairs. The rabbi and I headed out into the snow. And Justi and Boyer bundled up for a one-night honeymoon in a White Plains, N.Y., hotel. They said they’re prepared to face whatever comes next together — in sickness and in health.

This story is part of a partnership that includes WNYC, NPR and Kaiser Health News.

How a 'Bad Food' Attitude Can Backfire

Do you struggle with cravings and wish you had the will power to cut out certain foods completely? When we work toward a healthy diet, so many of us think that making a list of food culprits and calling them off-limits will help us to succeed. However, if you take a deeper look at the psychology behind this flawed method, you’ll see so many reasons why adopting a ''good food'' or ''bad food'' attitude will never work.  Restricting certain foods won't just make dieting miserable--it can also ruin your good intentions of getting healthy and losing weight. Making arbitrary rules about good and bad food isn’t the answer to lasting lifestyle change. Instead, use the tips below to build a better relationship with food, learn to master cravings, build self-control and enjoy all foods in moderation.   Stop Labeling Foods as 'Good' and 'Bad' For decades, behavior analysts have studied the effects of deprivation on people’s preferences for food, tangible items and activities. The majority of literature on this topic says that, when we’re deprived of something, we’re more likely to select that particular item from an array of choices. In a recent study conducted at the University of Toronto at Mississauga, researchers found that participants who were asked to restrict either high-carb or high-protein foods for three days reported higher cravings for the banned foods. So, if you label chocolate as evil and forbid it from your menu, you’ll be more likely to want it in any form.   The good news is that some level of satiation (satisfying your craving for a particular food) can actually help you to avoid overindulging more often than not. If you can be conscious about your eating and have just enough of your favorite chocolate bar to satisfy that craving, you’ll be much less tempted to dip into the candy jar on your co-worker’s desk or buy a sweet snack from the vending machine.   This information about deprivation seems like common sense, but you’ve probably heard from friends or fellow dieters that the first step in avoiding high-calorie foods is putting them out of your mind altogether. Not true! Researchers are realizing that suppressing thoughts about a particular food can cause an increase in consumption of that food. In a 2010 study, 116 women were split into three groups. The first group was asked to suppress thoughts about chocolate, the second group was asked to actively think about chocolate, and the third group was instructed to think about anything they wished. Afterward, each of the participants was given a chocolate bar. The women who had suppressed their thoughts about chocolate ate significantly more chocolate than the others, despite identifying themselves as more ''restrained eaters'' in general. This just goes to show that ''out of mind'' doesn’t necessarily always mean ''out of mouth.''   Dump the Idea of 'Diet Foods' Often, when people are trying to eat better, they start to categorize foods into those that are on their diet plan and those that are not. However, banning specific foods from your weight-loss plan may just make you crave them more.  According to an article published this year in the journal Appetite, a UK study of 129 women measured the cravings of those who were ''dieting'' to lose weight, ''watching'' to maintain their weight, and not dieting at all. The researchers found that, compared with non-dieters, dieters experienced stronger, more irresistible cravings for the foods they were restricting.   Noticing the difference between healthy and unhealthy options is definitely key in establishing a pattern of better eating. And, when you’re starting a weight-loss program, it does help to read food labels and menus carefully so that you can choose wisely. However, when you start to categorize specific foods such as candy, baked goods, alcohol and fried chicken as foods you can’t have, you’re setting yourself up for a backfire. The issue with labeling a food as a forbidden substance is that your thoughts immediately center on that particular item... and then you inadvertently start bargaining and rationalizing to get more of it. (How many times have you broken your ''diet rules'' to reward a trip to the gym with chocolate or a long day at work with a cocktail or two?)   There are some diet plans out there that advocate choosing a particular day of the week as your ''cheat day''--a day when you can indulge in all the foods you’ve cut out during the week. But listing certain foods as ''cheats'' or ''treats'' can set up a scenario where you’re depriving yourself all week long and constantly looking to the future, waiting on the moment that you’ll be showered with your favorite forbidden goodies (like those commercials where fruit-flavored candies fall from a rainbow).   Besides causing you to crave, labeling certain foods as ''forbidden'' makes it really difficult to be mindful of and content with the healthy food you’re eating most of the time. Instead of worrying about restricting foods, try to redirect your focus on creating the most delicious salad, grilling a succulent chicken breast or munching a juicy piece of fruit. If you turn your attention to the abundance of healthy options in front of you instead of weighing the pros and cons of particular foods, you’ll be more likely to really relish and rejoice in your everyday choices.   Make Sense of 'Moderation' You’ve heard the line a thousand times: Everything in moderation. But what does this phrase really mean and how can you apply it to your healthy eating plan? Usually, people hand this advice out when they’re indulging in unhealthy food and drink and trying to get you to join in, say at a wedding or birthday party. So is it just peer pressure? Or is there something to this age-old saying?   Choosing to eat all foods in moderation works just fine for some people. If you have a healthy relationship with food (e.g., you have no trouble putting away the bag of chips after just one serving), then eating a little bit of your favorite food may satisfy your craving and leave you full until the next healthy meal.   However, for some people, it just doesn’t work that way. Sweets, salts and alcohol all cause biological reactions in the body that are hard to ignore. And, if you’re someone who responds strongly to these reactions, even one small bite can trigger you to continue sampling similar goodies. If you’re one of these folks, you’re definitely not alone, and it is important to know which foods affect you in these ways. Perhaps you’re a person who can have a bite of a sundae and pass the rest on to your spouse, but a fun-size candy bar can unravel your motivation and spark unhealthy choices for the rest of the day. Noting which tempting foods are your triggers can help you arrange your environment so that you don’t overindulge.   Rearranging your environment for success is the easiest way to change your behavior. If you do decide to indulge in a ''trigger food'' in moderation, opt to eat it in a place where there aren't any other snack options for you to munch on afterwards (a food-filled party would not be the best environment!). Choose snacks that you like, but don't love, so you're not tempted to eat too much but are still satisfied. Understanding which foods are likely to lead you down a slippery slope and preparing your environment and schedule for success will help you keep cravings at bay and keep your overeating under control.   Keep Cravings in Check Cravings are a good thing. On a basic, biological level, cravings tell us when we’re hungry, thirsty, sleepy and even when we need some human attention. The problem is that, because we’re so accustomed to having easy access to eat whenever we want and we’re able to choose from many unhealthy foods, the ratio of our wants and needs are all out of whack! It is time to step back and become aware of what we’re really craving and why. When we can look objectively at our yearnings for soda, chips, cake and cookies, we can make much better decisions about what we put in our mouths.   One of the best ways to get back in touch with your true cravings is to keep track of them.  For a few days, keep a journal of the time of day, what you’re craving, and whether you’re at work, at home, on the road, with your kids, etc. You can still give in to temptation—this exercise will simply give you a clearer picture of how often you crave, what you crave and in what settings those cravings occur.   In behavior science, before we try to change any habit, we do an assessment like this to look at the person’s current patterns so that we can set goals for small, stepwise changes. You’ll likely notice a pattern quickly (e.g., I always want something sweet with my 10 a.m. coffee). Then you can put some measures in place to deter this craving or make a healthy choice before it happens (e.g., I’ll start bringing a piece of fruit to eat with coffee so I don’t grab a muffin from the break room).   With a little mindfulness, you can ditch the ''good food, bad food'' attitude! Plan carefully and stay in tune with your body to make sensible decisions that will satisfy your cravings and promote weight loss.        References:   James A.K. Erskine & George J. Georgiou. 4 February 2010. Effects of thought suppression on eating behaviour in restrained and non-restrained eaters. Appetite 54, 3 (2010):499-503.   Jennifer S. Coelho, Janet Polivy, C. Peter Herman. 16 May 2006. Selective carbohydrate or protein restriction: Effects on subsequent food intake and cravings. Appetite 47, 3 (November 2006): 352-360.   David B. McAdam, Kevin P. Klatt, Mikhail Koffarnus, Anthony Dicesare, Katherine Solberg, Cassie Welch, & Sean Murphy. The effects of establishing operations on preferences for tangible items. Journal of Applied Behavior Analysis 38 (2005): 107-110.   Anna Massey & Andrew J. Hill. 18 January 2012. Dieting and food craving. A descriptive, quasi-prospective study. Appetite 58, 3 (June 2012): 781–785. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1770

Break Out of Your Food Rut!

What's for dinner? What are you eating for breakfast or lunch tomorrow? If you aren't feeling excited about your meals, or if your kids are complaining about eating chicken again, you may be in a food rut.   It happens easily; between work obligations, social plans, and kids' soccer practices, we tend to fall back on easy-to-prepare staple meals that don’t require much thought or effort. And for some of us, cooking doesn’t come easily or isn’t a pleasure, so we rely on a handful of recipes we can confidently prepare.   While it's wonderful to have a few go-to meals you can rely on in a pinch, it can get old when you rely on the same meals too often. And that lack of excitement about what's on your plate could lead you to reach for additional snacks or sweets to bring more pleasure back to your eating—which can be a problem if you're trying to manage your weight or eat healthier.   We recently asked SparkPeople members if they were stuck in a diet rut, and we were surprised by how many people replied. Member CHOUBROU summed it up this way: ''The food rut is my biggest problem! I fall into it because eating the same go-to meals is convenient and easy. But eventually I get tired of eating the same thing, and that leads me to the temptation of eating out more, eating more frozen/processed meals, etc.''   SparkPeople member KALENSMOMMY5 asked for help: ''One of the main reasons I fall off the healthy eating wagon is that I get caught in a major food rut! As I am a full-time working single mom to a toddler, I have very limited time to cook, so I end up buying the same grab-and-go foods week after week. The unhealthy choices start to look more and more attractive as I get more bored with my standard foods. Help would be much appreciated!''   Lots of folks told us they’ve hit the wall, cooking-wise. What’s more, they shared great advice on how you can break boring food habits, no matter what causes them.   5 Signs You're Stuck in a Food Rut (and What to Do about It)   Sign #1: You Don’t Enjoy Cooking For many folks, getting dinner on the table is a chore, not a pleasure. If you don’t love to cook, or you’re not confident in your culinary skills, then it's normal to feel like you're in a food rut for awhile—at least until you develop a few basic meals that you can prepare quickly and easily. Here’s how:

  • First, think about what you enjoy eating. Sandwiches? Burritos? Breakfast for dinner? Salads? Consider how you can make those into healthy dinner options.  
  • Settle on three to five things you like, and find simple recipes for those meals. SparkRecipes is a great resource for quick and healthy meal ideas.  
  • Get comfortable with the basics. Once you’ve mastered an essential technique like sautéing boneless chicken breasts, then you can move on to experiment with different sauces or add-ins to change things up over time and prevent yourself from getting bored.  
  • Accept that you don’t love to cook, but don’t let that be your excuse for not eating healthy. If you master a few basic recipes, you’ll gain confidence—and you’ll be making a commitment to yourself.
Sign #2: You’re On Auto-Pilot Even accomplished home cooks tend to get stuck in a rut preparing the same go-to dinners over and over. Katie, a mother of two, posted: ''[My son] calls me on my food ruts—I know I've got problems when my garbage disposal of a kid complains about what I'm cooking.''   Like many folks who commented on our question about food habits, Katie says she refers to cooking magazines (her favorite is Food and Wine) for inspiration when she’s stuck in a routine. Cooking Light magazine and the books ''Cook This, Not That'' by David Zinczenko and Matt Goulding, and ''Fast Food My Way'' by Chef Jacques Pepin were also recommended as great resources for quick and healthy meals.   David posted about different ways to find culinary inspiration: ''I realize [I’m in a food rut] when I’m on auto-pilot preparing a meal that usually gives me joy to cook. I break it up by shopping somewhere new for groceries, or getting a new cooking gadget, or sharpening my knives or getting a new spice.''   A simple strategy for busting out of the auto-pilot cooking rut is to find alternate ways to prepare those go-to meals—in particular, look to different ethnic cuisines for interesting takes on your standards. If spaghetti with meat sauce is in your repertoire, try linguine with spicy shrimp sauce instead. Not feeling that leftover chicken? Turn it into something new, like a tostada. Sometimes simply swapping a few ingredients within a go-to recipe can give you a whole new flavor and make your meals interesting again. Same with sides: If you're always steaming broccoli or brown rice, experiment with other healthy veggies or whole grains such as whole-wheat couscous, millet or quinoa instead.   Sign #3: You Always Eat the Same Meals This food rut often shows up at the start of the day, when we’re so busy getting out the door that we neglect a healthy breakfast, or we choose convenience foods over healthy ones. SparkPeople member LINDSAYHENNIGAN commented that she found herself eating high-fiber breakfast cereal every day: ''I got too focused on how much fiber they added, and failed to notice the 40 grams of sugar I was consuming each morning. My trainer caught it, and switched me over to bread with 2 or less grams of sugar with peanut butter, and I feel so much better.''   SparkPeople member FLUTTEROFSTARS, a vegetarian, shared a bunch of great ideas she enjoys to start her day: ''I’m fighting to get out of my food rut! I’ve been 'Sparking' for two months now, and have come up with several winning mini-meals.'' Some of her favorites include:
  • Salad with Morningstar veggie crumbles and low-fat cheddar cheese
  • Omelets with frozen vegetable blend
  • Greek yogurt with strawberries and flaxseed
  • The ''one-minute microwave muffin'' recipes for breakfast sandwiches from SparkRecipes
We all go through busy periods in our lives—a hectic few weeks at work, an extra-busy sports season—and getting a healthy dinner on the table every evening is even more challenging. Creating a weekly meal plan and then shopping for all the ingredients you’ll need helps avoid the food rut. When you know in the morning what you’re making for dinner that night, you can avoid grabbing quick and not-so-healthy items on that emergency trip to the grocery.  And planning dinners that can be repurposed into lunches avoids brown-bag boredom.   Sign #4: You’re Bored with Brown Bagging We’ll congratulate you for committing to bringing a healthy lunch instead of heading to the nearest fast food joint. But the contents of your brown bag need an overhaul if you’re stuck in the PB&J or turkey sandwich routine day in and day out.   Turning dinner into lunch is a great way to vary your midday meal, especially if you plan ahead and prepare extra food in the evening for the next day’s (or week’s) lunchbox. A dinner of grilled steak and veggies can become a lunchtime salad, and a pasta supper easily transforms into a chilled pasta salad a day later.   SparkPeople member FELIFISH26 posted: ''I usually eat the same boring thing for lunch (half a turkey sandwich on sandwich thin bread, cottage cheese, low-fat chips). BLAH, right?! After awhile your taste buds start to get used to it all, and I could probably be eating cardboard and not know the difference!'' She solved her lunch dilemma by combining some cooked chicken from dinner the night before with fresh pico de gallo that she made with chopped tomato, onion and cilantro. New lunch idea: chicken tacos.   Sign #5: You’re Stuck on ''Diet-Safe'' Foods Several SparkPeople members commented that their commitment to weight loss means they have a limited number of meal options that meet their calorie limits. Member STACYD16 wrote, ''I do believe that I'm in a food rut. I eat the same things daily because I know their caloric contents. I do have a cheat day about once a week that I really enjoy—and I thought that would throw me off, but it has really helped. I realized my issue is more portion control vs. the actual foods that I eat.''   While eating within a calorie range can be a challenge, portion control can help. You can also search for specific recipes within a certain calorie range by using the Advanced Search on SparkRecipes.com. So if you want slow-cooker dinners that contain fewer than 400 calories, simply edit your search options and voila! You'll be surprised just how many delicious and easy meals you can find within your calorie range for any meal.   When All Else Fails: Embrace the Rut Here’s one final strategy for breaking out of your food rut—know that you’ll get into one. Steve posted about exactly that: ''Another thing I'll do is the mid-week ‘king's food’ omelet—where, no matter what, I'll cook an omelet using the leftovers of previous meals. This does two things: It creates interesting flavors with combos I’d normally never think of, and it motivates me to cook good stuff early in the week because it's potential omelet fodder.''   Just as you can't expect perfection when it comes to eating within your calorie range, losing two pounds per week, or exercising as much as you'd like, you can't expect to be perfect in the kitchen, either—or to love every bite you eat. Accept that we all go through ruts with our food. But instead of allowing it to throw you off track, use it as a sign to change things up and find creative ways to make your food fun and delicious again. And remember, this (food rut) too, shall pass!   Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1759

How to Grow Your Own Herbs for Cooking

The next time a recipe calls for fresh basil, skip the poor substitute of dried basil, forgo the last-minute dash to the supermarket for some overpriced wilted basil, and just pluck a few tender leaves off of the basil plant you have growing in your very own herb garden.  What? You don't have fresh basil growing in your garden? Well consider this your invitation to start. Growing your own herbs is a simple and inexpensive undertaking that pays off big for your taste buds and your budget.  If you can keep a houseplant alive, you can sustain an herb garden.  Here’s how. Decide what you want to grow.  Some popular choices from home cooks are listed here along with their care instructions.  Start with just a few that you know you’ll use regularly, and then branch out from there. Herb Special Care How to Harvest How to Use Basil Pinch off any flowers that appear. This preserves the plant’s flavor, and will also help increase the leaf density of each stem. Harvest the upper leaves first, taking just a few leaves from each stem at a time. Add raw to salads, sandwiches and wraps, cook into soups and sauces, chop and sprinkle on pizza, make pesto. Parsley Parsley has a longer than average germination period of three to four weeks, so extra patience is required. Cut the outermost stalks just above ground level, which will encourage further growth. Both the leaves and stalks can be eaten in salads, soups, and Mediterranean dishes like Tabouli. Chives If you don’t intend on eating the flowers, pinch them off as soon as they begin to appear. Cut the leaves with scissors, starting with the outside leaves first, allowing about 2 inches of the leaves to remain. This entire plant can be eaten from top to bottom— the bulbs taste like mild onions, the leaves can be used in salads and other dishes, and even the flower heads can be tossed into salads. Cilantro Cilantro does not like hot weather. If the soil temperature reaches 75 degrees, the plant will bolt and go to seed, making this a short-lived herb. Aggressive pruning will extend its life, so be ready to use or store it. Save the seeds to use in cooking (the seeds are called coriander) or to plant. There are two methods of harvesting cilantro. When the plant reaches about 6" in height, you can remove the outer leaves with a scissors, leaving the growing point intact for new growth. Or you can wait until the plant is almost completely grown and pull it from the soil by its roots to use the whole bunch at once. Salads, wraps, dips, and many Mexican recipes. Rosemary This plant can be difficult to start from seed, so you may wish to buy a mature plant. And be careful not to overwater—rosemary likes its soil on the dry side. Simply cut off pieces of the stem as you need it. Many culinary and even medicinal uses. Thyme This plant can take awhile to start from seed, so you may wish to buy a mature plant. Drought-tolerant thyme is extremely easy to care for, and prefers drier soils. Simply cut off pieces of the stem as you need it. Often used to flavor meats, soups, and stews. Dill Drought-tolerant dill is extremely easy to care for, and prefers drier soils. Don't start harvesting dill until it's at least 12 inches tall, and never take more than one-third of the leaves at any one time. Great flavoring for fish, lamb, potatoes, and peas. Mint Mint is an invasive plant so stick to container gardening with this one. Pinch off sprigs as you need them. Mint is extremely versatile, and can be used in salads, desserts, drinks, and many other recipes. You can even chew it by itself for a pleasant, refreshing flavor.   Decide where to plant your herbs. Many herbs grow well indoors and outdoors in the ground or in containers.  If you have a little space with at least 5 hours of direct sunlight a day, you may prefer to grow them indoors, as the herbs will be much more accessible for cooking and watering, and not subject to threats of pests, weeds, or variations in temperature. Decide whether you’ll start from seeds or seedlings.  Seedlings are very young plants that you can transplant into your own garden. They are typically only available in the spring and summer from gardening centers and farmers markets.  Seeds cost less, but take more time and resources to grow from scratch (here's how). Gather your materials.  You’ll need a few gardening tools, like a small shovel or spade, some gardening gloves and pots or containers (optional since herbs can also be planted directly into the soil). You’ll also need some fertilized soil.  If you have a compost pile, you can use some fully decomposed compost to fertilize the soil.  Otherwise, you can use a general purpose compost solution, available in any gardening store.   If you’re container gardening, use a packaged potting soil mix, which will be free of pests. Start planting.  If you’re starting from seeds, sow into moist soil and cover with 1/2 inch of soil on top.  The seeds should germinate in about one week.  If you’re using a pot or container for seedlings, follow these steps.

  1. Ensure proper drainage by filling the pot with a shallow layer of course gravel.  
  2. Fill the pot about 1/2 of the way full, and place the plant, still in its original container, into the new pot.  Add dirt around the plant, gently packing it into place, so that the top of the new soil is at the same level as the top of the plant’s original soil.   
  3. Remove the plastic pot, tap it so you can easily slide the plant and all of its soil out, and place the plant and all of its soil into the hole in the soil of the new pot.
Care for your plants. Water at the base of the plant when the soil begins to feel dry, at least once per week.  Pull weeds that appear near the plant, because they will steal the nutrients from the soil.  If growing outdoors, bring them in before the first frost. Harvest the herbs.  Most plants will grow new leaves if you don’t pick the stems bare. You can pick the leaves with your fingers or snip them with kitchen shears. Use or store the herbs.  Many recipes call for fresh herbs, so simply pick your herbs, wash them and pat them dry before using in your favorite recipes. To store, you can preserve your herbs for future use by freezing them or drying them.  In either case, you must first prep them.  First, remove any soil or bugs by rinsing in cold water.  Then, remove flowering stems and flowers and gently remove excess water by patting with a paper towel.  Once your herbs are prepped, you can choose your method of storage:
  • Air drying:  Cut the stems at soil level and hang upside down in bunches (so that the flavorful oil travels into the leaves) to dry for one to two weeks.  Once dry, remove the leaves from the stems and store in a dry, airtight container for up to a year.  
  • Freezing:  The benefit of freezing, as opposed to drying, is that the herbs retain more of their just-picked flavor.  Place clean herbs directly into freezer bags, or try the cube method: Place a few teaspoons of chopped, fresh herbs into each cell of an ice cube tray.  Fill the trays with water, and freeze.  When cooking, just pop out a cube and add it to the pot like you would fresh herbs!
Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1739

8 Tips for Deciphering Diet Claims

Though food is supposed to be one of life's simple pleasures, few things cause more angst and confusion. It's no wonder why. We're constantly being told which foods we should eat to be healthy, which diets we should follow to be skinny, which preparation methods we should use to be safe, and which chemicals and contaminants in food we should shun to avoid illness. It's enough to give anyone indigestion. If you're confused about what to believe, you've come to the right place. In "Coffee Is Good for You," I'll give you the bottom line on an array of popular diet and nutrition claims in a quick, easily digestible way. Research about diet and health rarely yields the equivalent of DNA evidence, which provides incontrovertible proof. All types of studies come with caveats. However, if interpreted properly, a body of research can allow us to make sound judgments about how believable a claim is. Trying to make sense of the seemingly endless stream of food and nutrition claims can be overwhelming. Remembering the following 8 rules will make the task easier and allow you to stay focused on what’s really important:

  1. Don’t fixate on particular foods. Be wary of lists of miraculous “superfoods” you must eat or “toxic” foods you should never touch. Rather than worrying about squeezing one food or another into your diet, focus on your overall eating patterns, which should include plenty of vegetables, fruits, whole grains, fish, legumes, and good fats, and limited amounts of refined carbohydrates, junk food, red meat, and trans fats.  
  2. Look beyond narrow categories like carbs and calories. Many diet books and seals of approval on foods emphasize one or two factors, such as the calorie or carbohydrate count, while giving short shrift to other important things, like fiber, sodium, or trans fat. The fact that a hamburger is lower in calories than a salad doesn’t necessarily make it a better option. Likewise, just because fruit punch or cereal has added vitamins doesn’t mean it’s healthful. What’s important is the overall nutritional profile. You can get this from comprehensive food- scoring systems such as NuVal, which ranks the healthfulness of foods based on more than 30 factors.  
  3. Forget about fad diets. A plethora of weight- loss plans promise to melt away pounds quickly and easily. But in the long run, they rarely work. About 95 percent of dieters eventually regain lost weight. Instead of searching for the secret to skinniness, which doesn’t exist, try to eat more healthfully and be mindful of how much you’re consuming. Combined with exercise, this approach can prevent weight gain and, over time, lead to weight loss. And unlike dieting, it’s something you can stick with long term.  
  4. Recognize the limits of vitamin pills. While vitamin and mineral supplements can help make up for deficiencies of nutrients, they generally don’t live up to their billing when it comes to preventing disease, boosting energy, or improving your overall health. Supplements pack far less nutritional punch than food, which contains multiple nutrients that interact with one another and with other foods in a variety of complex ways. As a result, vitamin pills can’t compensate for an unhealthful diet. And they can cause harm if you take too much of certain nutrients.  
  5. Ignore health claims on food packages and in ads. A few such claims, such as those related to sodium and high blood pressure, are officially approved by the FDA, but most aren’t. They fall under a loophole that allows companies to use sneaky language like “helps maintain healthy cholesterol levels” or “helps support a healthy immune system.” Because these phrases don’t explicitly say that the food prevents or treats disease— even though that’s what any normal person would infer—manufacturers don’t have to provide any evidence. What’s more, there are no strict definitions for frequently used terms such as all natural, low sugar, and made with whole grains or real fruit. Because it’s virtually impossible to distinguish between legitimate and misleading claims by manufacturers, the best approach is to disregard them all and get your information from the Nutrition Facts panel on the package.  
  6. Verify emails before forwarding them. The vast majority of emails about food and nutrition are half truths or outright hoaxes. If someone forwards you an email claiming, for example, that canola oil is toxic or that asparagus cures cancer, assume it’s not true, no matter how scientific it sounds. Check it out with a reputable source like Snopes. com or Urbanlegends. about. com. Forwarding unconfirmed claims only adds to the hype, misinformation, and confusion.  
  7. Don’t be influenced by just one study. When you encounter news reports about the latest study, don’t jump to conclusions based on that alone. Remember that it’s just one piece of a puzzle. What matters is the big picture— what scientists call the totality of the evidence. For a credible overview of the science, check out online sources such as the Nutrition Source from Harvard School of Public Health, or newsletters such as Nutrition Action Healthletter, the Tufts Health & Nutrition Letter, and the Berkeley Wellness Letter. Or go to www. pubmed. gov and look up the research yourself.  
  8. Enjoy eating! As I said at the beginning of this book, all the admonitions about which foods we should and shouldn’t consume can make eating a stressful chore. But it doesn’t have to be that way. Using science as your guide, focus on the claims with the greatest credibility and relevance, and tune out the rest. That way, you’ll feel less overwhelmed. While following sound nutrition advice is important for good health, it need not spoil your dinner. Bon appétit!
   Adapted with permission from "Coffee is Good for You" by Robert J. Davis, PhD, by arrangement with Perigee, a member of Penguin Group (USA) Inc., Copyright (c) 2012 by Robert J. Davis, PhD, MPH. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1725

In Deep-Red Western N.C., Revered Congressman Leads Charge Against GOP Bill

HIGHLANDS, N.C. — In this corner of Appalachia, poverty takes a back seat to art galleries, country clubs, golf course communities, five-star restaurants and multimillion-dollar houses.

From this perch, Rep. Mark Meadows, a real estate entrepreneur who capitalized on the area’s transformation into a prosperous retirement and vacation community, rose to political power quickly. Now the conservative Republican leads the House Freedom Caucus, controlling between 30 and 40 votes in Congress and showing few qualms about endangering his party’s best chance to repeal the Affordable Care Act.

“I am willing to invest the political capital to get it right,” Meadows, who has called the GOP replacement “Obamacare Lite,” said Thursday on MSNBC. “The next week is critical.”

And on Saturday, Meadows went to President Donald Trump’s Mar-a-Lago Club in Florida to negotiate over the bill with Trump aides, along with with Sen. Ted Cruz (R-Texas) and Sen. Mike Lee (R-Utah).

Meadows’ confidence is warranted.

His gerrymandered district covers 17 counties, spanning 150 miles across western North Carolina. The populous liberal bastion of Asheville is mostly carved out of his district like a bite from a cookie. What’s left is a retiree-rich constituency of 750,000 people that is heavily Republican, mostly white and lives mainly in small, rural towns amid pockets of extreme wealth. Its survival could hinge on a Supreme Court ruling expected this year in a case alleging racial bias in the state Legislature’s 2011 redrawing of North Carolina’s congressional map.

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Elected in 2012, Meadows, 57, has rebelled against the establishment Republican Party — helping shut down the government in 2013 and ousting Speaker John Boehner in 2015.

While Democrats and even moderate Republicans decry House Speaker Paul Ryan for cutting federal aid to help get people insured in the GOP bill, Meadows says the cuts don’t go deep enough. He vows to oppose any ACA replacement that does not bring down health costs for people and government. No such plan that actually controls costs is on the table, however.

Meadows wants to cut off all 10 million Americans who today get federal subsidies to buy health coverage, which he says the country can ill afford. With enough support, Meadows could either block the House leadership from passing its plan or force it to approve a more conservative replacement that would face little chance of getting through the more moderate Senate.

Meadows’ potential role as “Trumpcare” spoiler — is stirring concern in the White House and Congress. By Thursday, Meadows seemed to have gotten that message.

“The last thing I want is for the president to be mad at me,” Meadows told Politico. “He asked me to negotiate in good faith, so I have been working around the clock.”

[caption id="attachment_711840" align="alignright" width="370"] A lake in Highlands, N.C., is pictured. (Phil Galewitz/KHN)[/caption]

Meadows was absent, though, from a Friday meeting in the Oval Office with members of the Republican Study Committee, another group of conservative representatives, where Trump said he had secured enough votes to pass the House bill.

Meadows’ hard line doesn’t bother most folks back in western North Carolina, where Obamacare is unpopular. Only about 5 percent of those in his district receive government-subsidized health plans made available by the law.

Meadows, who now lives in West Asheville, moved to North Carolina from Tampa to raise a family in the 1980s. The proprietor of a small sandwich shop here in Highlands before he shifted to real estate, Meadows is revered by his constituents.

Even the local hospital industry — which typically opposes any effort to scale back the health law — remains firmly in Meadow’s corner.

“We are big fans of Mark. He’s a man of integrity and he has the heart,” said Jimm Bunch, CEO of Park Ridge Health, a 103-bed hospital in Hendersonville, N.C. He heaps praise on Meadows even as the congressman fights to eviscerate the law that helped the hospital achieve one of its best financial years ever. As more patients got insurance, Park Ridge gained $600,000 a year in funding it used to provide free care to other patients.

[caption id="attachment_711835" align="alignleft" width="270"] Jimm Bunch, CEO of Park Ridge Hospital in Fletcher, N.C. says the hospital made more money as a result of Obamacare subsidies but won’t bash the Meadows plan to take them away. (Phil Galewitz/KHN)[/caption]

Because North Carolina did not expand Medicaid under Obamacare, many poor adults remained uninsured. The state’s uninsured rate fell from 20.4 percent in 2013 to 13.6 percent in 2016, 2.5 points higher than the national average, according to Gallup.

Small-business owners, who provide most jobs in the district, are reluctant to take on Meadows., who is seeking to eliminate their government assistance to get health coverage.

At Sanctuary Brewing in Hendersonville, co-owner Joe Dinan said the Obamacare coverage he bought this year helped him get skin cancer surgery on his head. “I don’t want to see the subsidy end,” Dinan said. He won’t say anything critical about Meadows though, demurring that Hendersonville is a small town.

Meadows insists no one will get left behind.

He wants to allow people to buy less-expensive policies with fewer benefits than now required under the ACA. His tax help would be in the form of deductions people take at the end of the year or a break on their payroll taxes — different than both the current law and the Trumpcare plan working its way through Congress now.

It worries Rachel Lewicki, 30, who works at the local tea and spice shop on Main Street in Highlands.

Lewicki recently had surgery for a uterine tumor, paid for by a subsidized health plan she bought under Obamacare that costs her less than $100 a month. Now she fears her good fortune will end. “It’s not fair,” she said. “The way things are going, I’m scared and so are a lot of people who need this help.”

Kent Loy, a volunteer at a thrift store in Hendersonville, speaks of Meadows in harsher, personal terms.

“It’s an attack on the poor and how someone who claims to be a Christian can take this behavior is beyond me,” said Loy, 71. “This should disqualify him from office.”

[caption id="attachment_711822" align="alignright" width="270"] Joe Dinan, co-owner of Sanctuary Brewing in Hendersonville, used Obamacare subsidies to get coverage and deal with skin cancer this year. (Phil Galewitz/KHN)[/caption]

But it won’t, said Chris Cooper, professor of political science at Western Carolina University. Meadows has little to worry about in his heavily Republican district where he took 65 percent of the vote in November. “Taking out Asheville turned the district from being the most competitive district in the state to the most conservative,” Cooper said.

The political climate is challenging for cultivating grass-roots opposition, according to Susan Kimball, of Waynesville, N.C., who is part of Progressive Nation WNC, a group pushing to retain the ACA.

She said she has sought to meet Meadows in his district office several times to complain about his Obamacare stance, but to no avail.

Critics like her have recently pushed Meadows to hold a town hall meeting to hear their views, as many members of Congress did in the past month. His office said Meadows arranges such meetings only in August.

“I just feel like he doesn’t care,” Kimball said.

A cancer survivor, Kimball, 62, has benefited from Obamacare’s mandate that insurers provide coverage to people with preexisting health conditions. For $237 a month, Kimball has a subsidized Blue Cross plan that pays for visits to doctors and tests when she needs them.

She moved to Waynesville from South Florida four years ago, and the area’s conservatism has been an eye-opener.

“We were just moving to the mountains, and we didn’t know the region would become Tea Party central,” Kimball said.

KHN On Call: Answers To Questions On Tax Credits, Penalties And Age Ratings

For years, Republicans in Congress have promised to repeal and replace the Affordable Care Act, claiming that its requirement for nearly everyone to buy insurance or pay a fine is burdensome and costly, and that it doesn’t give people enough flexibility to get the coverage they need.

Now that they’re in charge, the bill they’ve released as an alternative (the American Health Care Act) would effectively eliminate the requirement to buy coverage and might open up more health care choices. It’s also under fire because it may cause millions of people to lose their coverage. According to the nonpartisan Congressional Budget Office, up to 24 million more people could be without insurance by 2026 if it passes.

So what are the differences between the ACA and the GOP alternative, and what does it all mean to you and your health care? We put some of your questions from our Twitter chat (#ACAchat) earlier this month to Alison Kodjak, NPR health policy correspondent, and Julie Rovner, chief Washington correspondent for Kaiser Health News.

Many questions came in about the elimination of the requirement to buy insurance, known as “the mandate,” and how the lack of one might affect the health insurance market.

Is the mandate in the GOP bill? It won’t work if people sign up only when they are sick.

.@sjp3121 I read mandate still there, just no fine. Is this accurate? #ACACHAT Won't work without mandate if only sign up when sick.

— ILPoliticalPug (@BarbinIL52) March 9, 2017

Kodjak: The mandate is technically still written into the law, but since no one will enforce it under this new bill, it’s unlikely to have any impact. In fact, the Internal Revenue Service has already issued some guidance that suggests it may not enforce the mandate very actively even now, before this bill becomes law. The result? People who think insurance is too expensive and don’t expect to need it are unlikely to sign up for a health plan.

Rovner: It’s true that the GOP bill technically preserves the mandate, but it eliminates the penalties. Instead, the bill would require those with a lapse in insurance of more than 63 days to pay an insurance premium that’s 30 percent higher for one year. Analysts say that could actually serve as a disincentive for healthy people to purchase insurance if they’ve had a break.

Can someone wait until they are sick to buy insurance, knowing that they would have to pay a 30 percent fine?

Thanks for doing #ACAchat. Can someone wait till they are sick to get insurance under cont cov rule even if they pay 30% more?

— AtoZ (@InOneFortyRLess) March 9, 2017

Rovner: Not exactly. There will still be standardized open enrollment periods once a year, and you will only be able to buy insurance outside of those windows if you have a life change, like moving or losing a job. But if you’re willing to wait as long as 11 months, then, yes, you can wait and buy insurance after you get sick.

Kodjak: It’s not without risk. The Department of Health and Human Services has already proposed regulations that would reduce that open enrollment period to six weeks from the current three months. So a patient may incur some health care costs while awaiting the open enrollment, and then face the 30 percent penalty when they do buy a health plan. However, if the individual has a health issue where treatment can wait, then they certainly can enroll at the correct time and then seek medical care.

We also got a lot of questions about the GOP bill’s new tax credits to help people buy insurance, and how different they would be from the structure of purchasing help in the ACA.

Explain the difference between tax credits and subsidies, and will tax credits be distributed quarterly or at the end of the year?

@NPRHealth Please explain the difference between tax credits and subsidies. Will there be quarterly tax credits or just year end? #ACACHAT

— songbirder74 (@songbirder74) March 9, 2017

Kodjak: Both the ACA and the AHCA use advanceable, refundable tax credits. That means the government each month sends the tax credit amount to your insurance company.

We refer to the Obamacare financial assistance as a “subsidy” in part because the amount fluctuates and is based on your income — the idea is to limit your health costs to a specific percentage of your income. In addition, under the ACA, there are payments to insurers to help cover the copayments and deductibles of lower-income people.

Rovner: The tax credits differ in how large they are and how they are calculated. The ACA tax credits are based on income and how much insurance costs in a given area. The GOP credits, by contrast, are based primarily on age and do not vary according to the cost of insurance in an area, so in low-cost parts of the country they will go further than in very high-cost areas.

In addition, the ACA has a series of subsidies that help those with low incomes (under 250 percent of poverty; about $50,000 for a family of three) pay their deductibles and other out-of-pocket expenses in addition to the tax credits to help pay for premiums.

Why does the GOP bill provide age-based tax credits instead of income-based ones?

#ACAchat @NPRHealth what's the policy behind providing age-based tax credits as opposed to income-based?

— molliegel (@molliegel) March 9, 2017

Kodjak: The basis for age-based tax credits is that people who are younger tend to have fewer health costs, so insurance policies are likely to be lower-priced for them than for older people.

Republicans prefer the fixed credits in part because they are cheaper, and more predictable, than the income-based credits under the Affordable Care Act. That’s because those ACA credits rise as premiums rise, giving insurers little incentive to keep their premiums low. Republicans hope that by restraining the government’s financial help to patients, insurance companies will offer cheaper policies that better match the cost of the tax credits.

Rovner: Younger adults, on average, need less health care than older adults. The ACA limited the differential in premiums for older adults to three times more than the amount charged to younger adults. The GOP bill would change that so older adults could be charged five times more. The change would make insurance less expensive for younger people, likely enticing more of them to enroll, and lowering premiums for all, at least marginally, according to the Congressional Budget Office. But it would dramatically increase premiums for older adults, particularly those aged 55-64, just under the age to qualify for Medicare.

Which brings us to this question, which represents several we received about how the AHCA appears to disproportionately penalize people ages 55-64.

Do I face a penalty for waiting to buy health insurance until I’m eligible for Medicare in three years? I’m concerned that I’ll be stuck with an expensive plan.

@SabrinaCorlette If I'm 62 and I decide 5:1 health insurance is too expensive and I wait for Medicare, no penalty for me, right? #ACAchat

— Anne Paulson (@KrampusSnail) March 9, 2017

Kodjak: No 30 percent penalty if you wait for Medicare, but remember, if you get sick while you’re waiting, you could be in financial trouble.

Rovner: That is correct. Also, remember, if you fail to sign up for Medicare when you first become eligible at age 65, you would also pay a premium penalty. It’s 10 percent per year, forever.

Got more questions? We’ll keep answering them as the GOP bill moves through Congress. Send them to us via Twitter at #ACAchat or via email at KHNHelp@kff.org.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

GOP Bill’s Unheralded Changes In Rules Could Undermine Health Of Neediest

An under-the-radar provision in the Republican proposal to replace the Affordable Care Act would require the millions of Medicaid enrollees who signed up under the Obamacare expansion to renew their coverage every six months — twice as often as under current law.

That change would inevitably push many people out of coverage, at least temporarily, experts say, and help GOP leaders phase out Medicaid expansion — a key goal of the pending legislation.

“That’s designed to move people off those rolls as soon as possible,” said Ken Jacobs, chairman of the University of California, Berkeley, Center for Labor Research and Education.

The proposal to cut renewal time in half is among other changes that seem only procedural but could have a profound effect on Medicaid enrollees’ health, pocketbooks and ability to get — and keep — coverage.

Another proposal would eliminate the ability of new Medicaid enrollees to request retroactive coverage for up to three months before the month they apply, which they can do under the current law — assuming they were eligible during that previous period.

Health care experts and advocates fear that could potentially saddle people on Medicaid with unaffordable medical bills, shortchange providers and raise costs throughout the health care system.

“These are changes to fundamental pieces of the Medicaid program,” said Cathy Senderling-McDonald, deputy executive director of the County Welfare Directors Association of California in Sacramento, which represents human services directors from the state’s 58 counties.

“They could result in people delaying their health care or having to pay out-of-pocket and not having any hope for reimbursement at all,” she said.

But Michael Cannon, director of Health Policy Studies at the libertarian Cato Institute, said some of these changes would prevent fraud and keep ineligible people from obtaining benefits, thus saving taxpayer money.

“It’s so hard to eliminate fraud in Medicaid, because someone always benefits from it,” he said. “They don’t want to give that up.”

The expansion of Medicaid — the federal-state health care program for people with low incomes, known as Medi-Cal in California — would be phased out under the Republicans’ plan starting in 2020.

The expansion, adopted by 31 states and the District of Columbia, added more than 11 million people to the rolls, including about 3.7 million in Medi-Cal. The federal government picks up a much higher proportion of the cost for this population than for traditional Medicaid enrollees.

In the GOP plan, people already covered under the expansion would continue to be funded by the federal government after Jan. 1, 2020, but if states opted to sign up new enrollees under the expansion criteria after that date, they wouldn’t receive the more generous federal funding for them.

And those who remained in the program after 2020 but later lost eligibility would not draw the more generous federal funding for expansion enrollees if they became eligible again and re-enrolled at a later date.

In California, the potential loss of federal dollars caused by the rollback of the expansion would be massive. The state Legislative Analyst’s Office estimated last month that the Golden State is slated to receive more than $17 billion from the federal government for the Medi-Cal expansion in 2017-18.

“We’re talking about a big shift in costs to the state of California and potentially a major loss in coverage,” said UC Berkeley’s Jacobs.

The GOP legislation, which is scheduled for a vote on the House floor on Thursday, would impose the new renewal requirement on expansion enrollees starting Oct. 1.

“They’re saying to states that do the expansion, ‘We’ll cover people who are continuously in the program, but we’ll make it really hard for people to be continuously in the program,’” Jacobs said.

Wolf Faulkins, a resident of Mariposa, Calif., who enrolled in Medi-Cal in 2014 as a result of the expansion, said the proposed rule change regarding renewal would add one more layer to Medi-Cal’s already considerable bureaucratic requirements, none of them logical or simple.

“If I were more of a senior citizen than I am now, I would be overwhelmed” by it, Faulkins, 61, said. “I would not be a happy camper.” But he would complete the extra paperwork, he added, because his Medi-Cal coverage keeps him alive: Among other things, he has a heart condition and high blood pressure as well as knee and hand ailments.

Senderling-McDonald said the new paperwork will lead some enrollees to drop out for two reasons: Either they’re no longer eligible, or they’re eligible but the new bureaucratic hurdle stops them.

Faulkins agreed. Even though he would jump through the necessary hoops to keep his coverage, some others probably wouldn’t, he guessed. “There are people who are just going to say, ‘It’s important, but it’s too overwhelming. There’s no one to advocate for me. There’s no one to help me figure this out, ” he said. “People are just going to get frustrated and say no.”

The new renewal time frame has a precedent in California, which adopted a semiannual reporting requirement in 2003 for some enrollees that lasted about a decade. Though it was less cumbersome than the regular annual renewals, it nonetheless resulted in people dropping from the rolls, Senderling-McDonald said.

But the Cato Institute’s Cannon believes six-month renewals are reasonable. “The savings from removing ineligible people would justify the paperwork involved,” he said.

The paperwork imposed by these changes could be the least of the headaches for Medicaid beneficiaries.

Retroactive benefits, for example, are extremely valuable for new Medicaid enrollees who face medical bills during a gap in coverage, and losing them could cause financial pain.

“If they have had health expenses, like having to pay for a prescription out-of-pocket or a doctor’s visit, or a woman goes into labor uninsured, they can say to the county, ‘I had medical bills. Can you see if I was eligible during that time?’” said Senderling-McDonald.

Pregnant women are among the most frequent beneficiaries because they often don’t know that they’re pregnant right away, she added.

The GOP bill would end this, and would allow coverage to begin only the month in which enrollees apply. This provision would affect all Medicaid applicants and, like the change in renewal time, would begin Oct. 1.

Some experts believe the proposed change would increase medical debt for consumers hit with massive bills, and for providers who ultimately won’t get paid for their services.

The three-month retroactive rule is “a big deal for hospitals as well as people, because it keeps them from being saddled with medical debt,” said Judith Solomon, vice president for health policy at the Center on Budget and Policy Priorities in Washington, D.C.

Senderling-McDonald warned that as more consumers racked up medical debt, the cost of it would shift to other people. “If someone has to declare bankruptcy when they are hit with bills they can’t pay, everybody else takes the hit for it,” she said. “They’re going to raise insurance rates or costs of care for everybody. People who have coverage through employers or the private market could see their rates go up.”

Cannon agreed that providers will get hit with more unpaid bills, but said that this provision would save the federal government money. “States have taxing authority and can fund these benefits themselves if they want to,” he said. “If they don’t, that should tell us something — that they don’t value these benefits that much.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

Finally, a Protein Bar You Can Feel Good About Eating

RXBAR

As often as we resolve to eat healthy, it's easy to get sidelined by convenience. You know what it's like—you swear you're going to make time for breakfast but snooze a little too long. You're not going to snack on chips again, but, well, that's what's there. Et cetera. Et repeat.

What you really want is a convenient and filling snack that you can trust is healthy. We became protein bar skeptics a long time ago (because hidden sugars exist, and they are scary), but RXBARs are the real deal—what you see is what you get, and what you get is gonna be stupidly delicious. It's also going to be soy free, dairy free, and gluten free, because why not?

The way we see it, RXBARs are a great replacement for all the junk you'd be eating otherwise. About to inhale a blueberry muffin? Sub in a blueberry RXBAR and feel smug that you just ate egg whites and cashews instead of processed carbs and sugar. Reaching for a brownie? Chocolate sea salt and coconut chocolate are just as tasty, and the protein makes them waaaay more filling.

Mint chocolate is light, refreshing, and perfect post-workout. Peanut butter is going to be 100 percent better than any sad peanut butter-toast combo you put together when you're starving mid-afternoon. Maple sea salt is what you need when you're itching for something sweet, and apple cinnamon is like a bowl of sugary oatmeal you can eat on the go—minus the added sugar.

We could go on, but the bottom line is this: Every time you eat an RXBAR, you're getting something filling and satisfying but healthy to the core. This isn't some chalky protein bar, nor is it a sugary dessert masquerading as a health food. It's exactly what it looks like, and that's why we love it.Bonus: Greatist readers who are new to RXBAR get 25 percent off their first order!

I Want to Try Them! | $20 for 12

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