The dangerous myths that prevent me from getting the endometriosis care I need

The dangerous myths that prevent me from getting the endometriosis care I need


The dangerous myths that prevent me from getting the endometriosis care I need

I’m sick almost every day, gently poking my distended stomach wondering when my pelvis is going to explode. I have debilitating cramps that begin mid-cycle, accompanied by nausea and a fever that breaks around the time I begin to bleed. At age 26, my OBGYN suspects that I have endometriosis, a disease in which uterine lining grows outside of the uterus, attaching to other organs. It has no known cure. In his plush Upper East Side office, he asks if I’ve considered getting pregnant; he tells me that it’s the best way to treat it. I’ve just opened my first adult savings account and don’t have a boyfriend, so no, I haven’t thought about giving birth to a child. I also don’t yet know his claim that pregnancy is a “cure” for endometriosis is a myth.

That year, unable to pull myself out of bed most mornings, I leave my life in N.Y.C. to live with my father in Georgia; he can add me to his company’s health insurance plan. I had been temping in Manhattan and coat checking at night, but these types of jobs don’t offer health benefits. My new doctor refers to my situation as a “working woman’s disease,” and explains that he can’t diagnose me until I have surgery. An ultrasound cannot detect the disease.

For over 6,000 years, women with heavy cramping, pelvic pain, or pain during intercourse have been dismissed by our patriarchal society—so much so that painful periods have been normalized. Doctors do not consider these symptoms medical red flags, but hysterical complaints by psychologically inadequate women with low thresholds for pain. 

Even doctors that do recognize women’s pain as a potentially serious condition are challenged by the lack of research and resources available.

“Endometriosis is a chronic disease, and with little treatment options, women can suffer for decades. The symptoms are vague and can be associated with other disorders like bowel disease. There are no laboratory evaluations that can be done,” says OBGYN Alyse Margaret Kelly-Jones. According to The Endometriosis Foundation of America, it takes approximately ten years for many of the estimated 200 million endo sufferers worldwide to be diagnosed.


My doctor discourages me from having a laparoscopy to remove the adhesions and endometrioma—cysts filled with dark brown blood formed from tissue similar to uterine lining—that have likely migrated outside my womb. Even after surgery, there is no way to prevent it from attacking my insides. So, I wait while collecting a pharmacy of pastel painkillers with too many side effects to take while working or driving or being awake. My treatment plan consists of extra-strength Tylenol, a heating pad, and sleep. On one hand, I count the number of good days I have each month. I pretend every day to be okay. My home in New York feels like a distant memory.

A few months after my doctor’s visit, I am rushed to the hospital for a ruptured cyst after an evening shift at the restaurant where I work. Now, they say I need surgery. The diagnosis is Stage IV endometriosis due to the large number of implants and endometrial cysts that were attached to my digestive tract, pelvic cavity, and rectum. After surgery, I’m told there is tissue left inside me because it was unsafe to remove it. I get to keep it.

Before the disease attaches itself to my insides again, the doctors go over my options: pregnancy (even though more than half of infertile women have symptoms of endometriosis), hormone injections that cause premature menopause, a hysterectomy.

I feel like I am in the dark ages: Have a baby now or remove the organ necessary to have children in the future. I read The Endometriosis Sourcebook for answers, but it is a mystifying disease with little money allocated to understand—or even agree upon—what kind of disease it is and what causes it. Almost all endometriosis websites include a myth versus fact section. While this may sound like progress, it’s a small win.

The myths are just as pervasive and toxic as the illness itself.

I move to Los Angeles because it’s sunny every day and I dream that the health-obsessed city will rub off on me. It’s only in photos that I notice how sick I look, which is curious to others because I don’t “act” sick. As a child, the gauge of sickness was the rise of silver mercury in a thermometer. I’ve learned that there are key symptoms that people respond to: vomiting, fever, broken bones, bruises. What do you do when all of your broken pieces are on the inside? Sometimes vomiting is really nausea; fever is the chills. I call my symptoms chronic fatigue. But am I more tired than a mother with three kids working two jobs? Who isn’t tired?

I shame myself into hiding my pain, but secrets have consequences. My consequences take the deformed shape of deep scar tissue. After my second surgery, they tell me it’s now or never for children. I now have a live-in boyfriend, but he is not ready. I’m not sure if I am either, but I know I want children, so it must be now. My pain is significantly reduced with Chinese herbs and acupuncture, but when I lose my job, I struggle to keep up with weekly sessions. I return to bottles of burnt orange pills and electric heat, and I am unable to carry a pregnancy to term. We miscarry more than once and turn our spare room into an office.


A Twitter search for #endometriosis yields approximately 2,000 posts in a week; the majority are declarations of excruciating pain or stories of not being believed. Images include a crying uterus and selfies in hospital beds. Hashtags like #endometriosissucks, #endometriosisisreal, and #endometriosisresearch are calls for support, solidarity, and action. @xMelissaR04 sums up what our insides feel like: “On my way to work & it feels like Freddy Krueger has his fingers in my uterus ”

In online support groups, the misinformation that young women receive from their physicians feels criminal to me. High school girls are studying for their driver’s exam while getting hysterectomies. After undergoing eight surgeries, Lena Dunham recently chose to have one, but since endometriosis grows over the uterine lining, she still may experience pain. Unlike Dunham, I imagine that these girls may not have the opportunity to get a second opinion. SpeakEndo.com notes that teens’ endometriosis symptoms are the most likely to be written off as bad cramps.

Founder of Seckin Endometriosis Treatment Center (SEC) and endometriosis excision specialist surgeon Dr. Seckin has a different definition of endometriosis. On his website, he writes, “This is endometriosis, menstrual periods that are literally stuck inside of a woman’s body. The implants can grow deep and wide, spreading and clinging to her uterus, appendix, rectum, ovaries, intestines, leg nerves, and other parts of the pelvic region. They are like leeches that attach to, reproduce on, and grow on whatever internal organs they find. They are similar to a slow-growing cancer that invades the organs in the pelvis. In some rare cases, they can spread to the diaphragm, lungs, kidneys, or brain.”

I have been battling endometriosis for over twenty years. It’s the longest and most toxic relationship I’ve ever had. A relationship I can’t escape.

Last month, I fastened my feet into another pair of stirrups, hopeful that a young doctor may have a more progressive approach. He locates a sizable cyst on my left ovary and a sac of fluid above it. “You haven’t been treating it, so I suspect that your endometriosis has grown back. Have you tried Lupron?” he asks me.

I know that several pharmaceutical companies who manufacture Lupron are being sued by a woman whose body attacked her bones after just two injections. “I know many people who’ve had negative experiences with it,” I tell him, which is the truth. He shrugs his shoulders and tells me that getting pregnant would be the best of both worlds. I have no idea what two worlds he is referring to.

While it wasn’t right for him to blame me, I haven’t been militant with my pain management. I stopped going to acupuncture, and even though I subscribe to a healthy vegetarian diet, yoga, and exercise, I’ve only dabbled in holistic treatments such as CBD or hemp oil, Reiki, and essential oils. The truth is, when I feel good, I want to forget that endometriosis exists.

I should have been better, I think—but then I stop myself.

Is this what it means for women to be advocates of their own healthcare? Does it rest on our shoulders to cure ourselves? There may be better ways for me to manage pain, but I didn’t ‘make’ my endometriosis grow back.


As I was writing this essay, I ended up in the hospital for severe pelvic pain, nausea, and the chills.

My blood work results appeared as emails on my phone as I sat in the waiting room. After watching every patient disappear behind the double doors, I asked the receptionist why I was being seen last. “Patients are categorized by the severity of their condition,” she said with a forced smile. I wanted to read her a recent article that cites endometriosis as one of the most painful chronic illnesses. Instead, I nodded and waited my turn.

“The cyst and fluid sac are gone. They must have ruptured,” the ER doctor tells me. “Endometriosis is a terrible condition; I am so sorry that we can’t help you.” I am not an emergency and I can’t be helped at the ER.

“The good news is that your vitals and blood work are great,” he says. “And your pregnancy test was negative.” I winced, knowing that I am nearing the end of my fertility window. I’m glad that he doesn’t pretend to know how to treat me or tell me that I could have cured myself. At least he doesn’t prescribe me a myth. Instead, he prints out the names of five OBGYNS who may have more experience with endometriosis. “They are excellent doctors,” he says, and I believe him because he believes me.

While new marketing campaigns urge women to “speak out” about their symptoms, history has shown that women who speak out are not believed.

We are not in the dark about endometriosis because women ignore their symptoms; we are ignored because women’s bodies are devalued.

This treatment by doctors has reprehensible effects. It falls on our shoulders to raise awareness and dispel myths that pregnancy and hysterectomies cure endometriosis. We need to band together to demand more studies, more funding, more understanding of women’s bodies. After all, it is our bodies that give life.

The post The dangerous myths that prevent me from getting the endometriosis care I need appeared first on HelloGiggles.

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Federal judge in Texas strikes down Affordable Care Act

A federal judge in Texas said on Friday that the Affordable Care Act’s individual coverage mandate is unconstitutional and that the rest of the law must also fall.


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De Blasio doesn’t care what parents think about his elite-school-quota plans

Deputy Chancellor Josh Wallack last week became the highest-ranking Department of Education official to face the public about the DOE’s plans for racial re-engineering of the city’s elite high schools. It didn’t go well: Most of the crowd of 350 parents from Manhattan’s District 2 jeered, booed and otherwise expressed their fury. Yet no amount…
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Must-Reads Of The Week On Health Care

Your regular Breeze correspondent, and its creator, Brianna Labuskes, is taking a break, but we didn’t want you to be without some semblance of a report today of things you don’t want to miss in health care.

So I’ll do my best at filling in. Be kind, and check back next week for the really good stuff.

One of the biggest bits of news this week was a coughed-up blot clot from the lung. Not sure why that seemed to fascinate people. We can skip that, but feel free to look.

The Atlantic: Doctors Aren’t Sure How This Even Came Out of a Patient

A more authentic bit of news was the report that health care spending slowed in 2017. It’s still growing, mind you, but growing more slowly. That’s not terribly surprising, because it has been slowing for a number of years. What Dan Diamond over at Politico calls “slowth.” It increased 3.9 percent to $ 3.5 trillion, while the year before it had grown 4.8 percent. Another way to look at it: Americans spend $ 10,739 per person on health care. HuffPost had a nice analysis:

HuffPost: America’s Health Care Spending Keeps Rising Really Slowly. Seriously.

Read the full report here.

The New York Times attempts to explain why enrollment in Obamacare is down. Any number of things could factor in, like higher employment at places that offer health insurance, no mandate forcing people to enroll or people signing up for Medicaid. Further study may present an answer.

The New York Times: Why Is Obamacare Enrollment Down?

This week, the Annals of Internal Medicine retracted a 2009 paper by Brian Wasinick, the now-discredited Cornell University researcher. The half-baked paper had claimed that the recipes in the more modern editions of the classic “Joy of Cooking” cookbook had more calories than the original. The always enlightening Retraction Watch website, which tracks medical and scientific research that has been undermined, has the whole story of the delightful sleuthing that led to the debunking. (And while you are on the site, peruse all the other Wasinick papers on food research that have been rescinded.)

Retraction Watch: The Joy of Cooking, Vindicated: Journal Retracts Two More Brian Wansink Papers

One of my favorite writers on health care makes an often overlooked point about health insurance: Its goal ought to be the same as other insurance, that is, to safeguard the financial health of beneficiaries. And Aaron Carroll, who is also a professor of pediatrics at Indiana University School of Medicine, says that several studies show it does exactly that.

Read the whole piece for yourself:

JAMA Forum: Medicaid as a Safeguard for Financial Health

As a bonus on this topic, here is an academic paper surfacing this week on the effects of the Affordable Care Act on mortgage delinquencies. Spoiler: The value of fewer evictions and foreclosures is substantial compared to the cost of the ACA subsidies.

The Effect of Health Insurance on Home Payment Delinquency: Evidence from ACA Marketplace Subsidies

The Commonwealth Fund, a foundation that seeks to improve health care,  wanted to know how the Affordable Care Act affected the uninsured and the insured. As its chart that summarizes its findings issued this week shows, there was considerable movement. The main finding was the number of young adults who switched from Medicaid to individual insurance — and the other direction as well.

The Commonwealth Fund: Who Entered and Exited the Individual Health Insurance Market Before and After the Affordable Care Act?

Commonwealth also conducted a forum on “Being Seriously Ill in America,” which dealt with the financial consequences.

Forbes likes to compile those “30 under 30” lists. (I’ve long wished someone would go back and look at one of those lists from 20 or 25 years ago to see how the luminaries are doing now.) Anyway, it put together a list of people in the health care industry. Most are on the cusp of 30, which might tell you something about how hard it is to get a fast start in the industry. But one person on the honor roll is only 18. In case you were wondering, because I was, Elizabeth Holmes, the founder of the ill-fated Theranos, was on a different “40 under 40” Forbes list in 2014. We hope these folks fare better.

Forbes: 30 Under 30 in Healthcare

This article ran a while back, but I got a kick out of it and just had to mention it. It looked at prehistoric health care. Researchers will never know how much Stone Age dwellers bored their hut mates with discussions of a paleo diet, but they are learning how they performed medical procedures that appeared to have worked.

The Atlantic: Neanderthals Suffered a Lot of Traumatic Injuries. So How Did They Live So Long?

May you survive another whirlwind week of health care news, until next Friday’s breezy recap.

Kaiser Health News

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What Women’s Election Day Victories Mean for the Affordable Care Act

Women’s economic security and access to health care have been under threat since long before President Trump took office, but his election acted as a catalyst—accelerating attacks on our bodily autonomy, health and basic rights. Trump and his allies have undermined the Affordable Care Act (ACA) in every branch of our government—pushing policies that destabilized the insurance market, caused premiums to skyrocket and expanded short-term junk insurance policies that don’t cover basic services like maternity care.

The midterm results were a direct reproach to that agenda. More women ran for and won elected office than ever before, often building platforms around protecting the ACA and pre-existing conditions—and health care was cited time and again as the top issue for women voters, who carried them to victory.

Feminists demonstrated at the Supreme Court in support of the Affordable Care Act in 2016 during oral arguments in a case seeking to weaken its contraceptive coverage mandate. (Victoria Pickering / Creative Commons)

None of this should come as a surprise. Women, especially women of color, have benefitted exponentially from the ACA. Since its implementation, 9.5 million women have gained health insurance and 55 million women are now guaranteed essential benefits like maternity care and birth control coverage, which were often excluded from policies previously. Before the ACA, insurers also routinely charged women up to 1.5 times more than men for the same policy because of common health issues like endometriosis, depression or even pregnancy, and nearly 80 percent of women become mothers but giving birth or having been pregnant was considered a pre-existing condition. Experts estimate that over half of all women and girls—67 million people—have pre-existing conditions.Thanks to the ACA, we’re now protected against that kind of gender discrimination.

The election of more than 100 women to Congress also served as a lightning rod of resistance against the scaled-up attacks on women’s reproductive health and rights that we’ve seen over the past two years, issues that go right to the core of women’s equality and economic security, and made clear a national demand for representation in Congress that reflects the current demographics and values of our country. Polls show that support for legal abortion is at historic highs among Democratic women voters, and growing among Republicans. (More than half of Republican women want Roe v. Wade kept intact.)

That’s also no surprise: One in four U.S. women will have an abortion before she’s 45, and those women are Democrats and Republicans. If we lose Roe, women everywhere will suffer—and women across party lines and state lines know that the right to our autonomy is the right to our destiny. Women know that the ability to choose if, when and how to have kids is inextricably linked to their economic success, health and wellbeing. Restricting or denying abortion access does irrevocable harm to our careers, families and economic security; research shows that women who are denied abortions and forced to carry pregnancies to term are four times more likely to experience poverty. Unwanted births also result in negative outcomes for children compared with planned pregnancies.

Make no mistake: the anti-abortion movement definitely had some wins this year, including the passage of personhood measures in Alabama and West Virginia and the confirmation of Judge Brett Kavanaugh to the Supreme Court. But the wave of feminists taking seats in the House come January will surely stymy some of the persistent efforts to shame, pressure and punish women for the decisions they make about their own lives that we’ve seen growing under Trump’s administration.

The majority of women voters cast their ballots for Democrats because they know women cannot be equal without reliable access to affordable health care and the ability to make choices about their bodies. In November, 41 percent of voters cited health care as the issue driving them to the polls. Women make up half of the population, the workforce and the electorate. Recognition for our voting power across party lines is long overdue, and guaranteeing women the right to plan their own families, and futures, is a fundamental part of that.

The historic wins for women on Election Day were also victories for the Affordable Care Act and the people who rely on its benefits—and that’s no coincidence. In Washington, the new feminists in Congress will have the great responsibility of echoing the message voters sent them in the midterms: respect women’s rights and protect our health care.

Margarida Jorge is the executive director of Health Care for America Now, the national grassroots coalition that ran a $ 60 million five-and-a-half year campaign from 2008-2013 to pass, protect and promote the Affordable Care Act and protect Medicare and Medicaid. HCAN has come back together to fight the Republicans’ all-out effort to take away America’s health care and put people at the mercy of the health insurance companies again.

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The post What Women’s Election Day Victories Mean for the Affordable Care Act appeared first on Ms. Magazine Blog.

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Claire Foy has a secret talent that the Queen probably wouldn’t care for

Watch the queen conquer.

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The day we found out Claire Foy wouldn’t be returning for Netflix’s The Crown was a dark day in our offices, however it’s been amazing to watch how she’s really let her hair down since then. Ever since hanging up her tiara and cloak, she’s taken a role that couldn’t further from the Queen if she tried as Lisbeth Salander in The Girl in the Spider’s Web and she’s now showed off a secret skill never before seen in Buckingham Palace. So if you’ve ever wanted to imagine a younger Queen Elizabeth laying down a sick beat and rapping flawlessly…Claire Foy’s got your back.

The Girl in the Spider’s Web star recently visited the set of The Tonight Show Starring Jimmy Fallon, where she chatted about her new projects and what life was like post-Netflix. While on the show, Fallon and the show’s resident band ambushed her.

‘I’ve heard some weird rumour on the internet,’ Jimmy Fallon began.

She instantly did what any sensible person would do and advised him, ‘Never trust the internet.’

Regardless, Fallon charged on and told her, ‘I heard that you know all the lyrics to Rapper’s Delight.’

If you’re not entirely sure what Rapper’s Delight is, it’s an iconic Sugarhill Gang song which starts ‘I said a hip hop’. (You know the one.) The moment Jimmy Fallon outed her love of the Sugarhill Gang however, she burst into laughter immediately and put her head in her hands.

Fallon told her, ‘You can always say no.’

However, he slyly looked over at the audience who cheered her on as the band started to play. And all props to her, Claire Foy took the microphone and proceeded to raise the roof.

You’re going to want to see the video, which is absolutely amazing to watch above. She somehow manages to nail the song while retaining a distinct posh Britishness about her, which is both endearing and hilarious at the same time.

TBH, we’re just annoyed Jimmy Fallon cut her off early as we could have easily watched an hour of her doing rap covers. Please, Claire Foy – drop a rap album. We’re begging you.

The post Claire Foy has a secret talent that the Queen probably wouldn’t care for appeared first on Marie Claire.

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New Congress To Tackle Burning Health Care Issues, Including Drug Prices

Voters ranked health care as the top issue facing the country after the midterms, according to CBS News exit polling. KHN senior correspondent Sarah Jane Tribble joined “Red and Blue” anchor Elaine Quijano to discuss how Republicans and Democrats are responding to the American public’s call to action — with a focus on skyrocketing prescription drug prices. Tribble and Quijano also explored how the midterms bolstered Medicaid expansion in a handful of states.


KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News

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Podcast: KHN’s ‘What The Health?’ Split Decision On Health Care

Voters on Election Day gave control of the U.S. House to the Democrats but kept the U.S. Senate Republican. That will mean Republicans will no longer be able to pursue partisan changes to the Affordable Care Act or Medicare. But it also may mean that not much else will get done that does not have broad bipartisan support.

Then the day after the election, the Trump administration issued rules aimed at pleasing its anti-abortion backers. One would make it easier for employers to exclude birth control as a benefit in their insurance plans. The other would require health plans on the ACA exchanges that offer abortion as a covered service to bill consumers separately for that coverage.

This week’s panelists for KHN’s “What the Health?” are Julie Rovner of Kaiser Health News, Rebecca Adams of CQ Roll Call, Margot Sanger-Katz of The New York Times and Joanne Kenen of Politico.

Among the takeaways from this week’s podcast:

  • The Trump administration’s new contraception coverage rule comes after an earlier, stricter regulation was blocked by federal courts.
  • The insurance bills that the Trump administration is now requiring marketplace plans to send to customers for abortion coverage will be for such a small amount of money that they could become a nuisance and may persuade insurers to give up on the benefit.
  • House Democrats, when they take control in January, say they want to move legislation that will allow Medicare to negotiate drug prices. But fiscal experts say that may not have a big impact on costs unless federal officials are willing to limit the number of drugs that Medicare covers.
  • It appears that both Democrats and Republicans in Congress are interested in doing something to protect consumers from surprise medical bills. The issue, however, may fall to the back of the line given all the more pressing issues that Congress will face.
  • One of the big winners Tuesday was Medicaid. Three states approved expanding their programs, and in several other states new governors are interested in advancing legislation that would expand Medicaid.

Plus, for extra credit, the panelists recommend their favorite health stories of the week they think you should read, too:

Julie Rovner: Kaiser Health News’ “Hello? It’s I, Robot, And Have I Got An Insurance Plan For You!” by Barbara Feder Ostrov

Margot Sanger-Katz: Stat News’ “Life Span Has Little to Do With Genes, Analysis of Large Ancestry Database Shows,” by Sharon Begley

Joanne Kenen: The Washington Post’s “How Science Fared in the Midterm Elections,” by Ben Guarino and Sarah Kaplan

Rebecca Adams: The New Yorker’s “Why Doctors Hate Their Computers,” by Atul Gawande

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcher or Google Play.

Kaiser Health News

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Tax cuts have been controversial, but voters didn’t seem to care about them

Voters in the midterms felt neither tremendously motivated by the 2017 tax cuts nor had their lives been changed much by them, NBC News exit polls find. 
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GUIDE TO THE AFFORDABLE CARE ACT: Affordable Care’s Still There

Was the Affordable Care Act (ACA) repealed? Dismantled? What about pre-existing conditions?

As a federal court weighs the constitutionality of the ACA, it’s the cost of health care, and the uncertainty of protections, that’s weighing on most Americans’ minds.

The good news for New Yorkers is “the…

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Trump administration courts investors in broad effort to combat rising health care costs

The Trump administration is battling rising health costs by going after higher prices.
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Affordable Care Act Open Enrollment Starts Nov. 1. Here’s How to Sign Up

When it comes to electing health care coverage, deadlines matter. Miss one, and you could find yourself facing thousands of dollars in medical bills down the road.

Starting Nov. 1 and ending Dec. 15 (in most states), uninsured Americans can sign up for coverage under the Affordable Care Act or renew the coverage they already have.

If you want coverage in 2019, you must enroll during these 45 days unless you later have a qualifying life event, such as getting married or divorced.

Some younger and healthier people may not think coverage is worth the monthly premiums.

But think again, says Gerald Kominski, a professor of health policy and management at UCLA.

“There’s the idea that ‘I take care of myself, I live a healthy lifestyle, I eat well, I don’t smoke — I’m going to be healthy and live forever,’” he says. “Nobody knows what the future holds. People with perfectly healthy lifestyles get sick every day.”

What’s New This Year Under the Affordable Care Act

For the first time since the Health Insurance Marketplace — a federally run service where people can shop for and enroll in private insurance — opened five years ago, Americans will not have to pay a financial penalty for failing to obtain insurance. But experts say it’s still critical to buy coverage.

It costs up to $ 7,500 to fix a broken leg, about $ 30,000 for three days in the hospital and into the hundreds of thousands of dollars to treat cancer, HealthCare.gov says. The average visit to an emergency room in 2016 cost $ 1,917, according to the Health Care Cost Institute.

Most working people can’t cover that kind of expense with their salaries or savings, says Kominski — who, three decades ago as a graduate student, needed an appendectomy that cost $ 15,000. Because he had a student policy, he says, his share was less than $ 100.

In addition, health insurance plans that provide free or low-cost preventive services and promote the early identification of problems reduce the likelihood that more expensive and extensive treatment will be needed later, said Jay Wolfson, professor of public health, medicine and pharmacy at the University of South Florida. Thus, they benefit even people who are healthy — or appear to be.

And when healthier people buy insurance, it costs less for everyone, he said.

How To Shop For an Insurance Plan in the Marketplace

Start by going to HealthCare.gov and clicking “get ready to apply” if you plan to enroll for the first time or “get ready to keep/change” if you had a 2018 plan through the Marketplace, also known as the “exchange.”

Some states operate their own exchanges. If you live in California, Colorado, Connecticut, Idaho, Maryland, Massachusetts, Minnesota, New York, Rhode Island, Vermont, Washington or the District of Columbia, you must apply through your state.

Application deadlines are slightly later in California, Massachusetts, Minnesota and Rhode Island, so be sure to call or check your state exchange’s website. In general, coverage begins Jan. 1, 2019.

Online, you’ll learn how to estimate your 2019 income for the application and find a checklist of information you’ll need, such a such as household size, the Social Security numbers and birthdates of your family members, W-2 forms or pay stubs and policy numbers of any current health insurance. Coverage is available only to U.S. citizens and legal residents.

With insurance through the Marketplace, you’ll pay a deductible and coinsurance — a percentage of a covered health service — of 10% to 40%, depending on which plan you choose. You’ll have to pay only up to an out-of-pocket maximum, and there are no yearly or lifetime dollar limits.

You’ll also get the benefit of discounts that insurance companies negotiate with health care providers. People without insurance pay almost two times as much for care, according to HealthCare.gov.

How to Apply, What’s Covered and What Help Is Available

You can apply by phone, in person with help from a navigator — a person specially trained to walk you through the process — through an agent or broker or by mail with a paper application. Volunteers certified by the Marketplace also may be available through nonprofit organizations such as community health centers or hospitals.

Coverage through the Health Insurance Marketplace is intended for those not covered by insurance at work or by government programs such as Medicaid, Medicare, Tricare (for members of the military, veterans and their families) or CHIP, the Children’s Health Insurance Plan.

Plans that comply with the Affordable Care Act, often called Obamacare, cannot discriminate against people with pre-existing conditions. They also must cover birth control and breastfeeding equipment and counseling, plus 10 “essential” services:

  • Outpatient care.
  • Emergency services.
  • Hospitalization.
  • Pregnancy, maternity and newborn care.
  • Mental health and substance abuse services.
  • Prescription drugs.
  • Mental and physical rehabilitation for people with injuries, disabilities or chronic conditions.
  • Laboratory services.
  • Preventive and wellness services and chronic disease management.
  • Pediatric treatment, including dental and vision care.

You’ll pay different premiums and out-of-pocket costs depending on the plan you choose. The government will subsidize your premiums if your income is between 100% and 400% of the federal poverty level.

Currently, that’s $ 12,140 to $ 48,560 for a single person and $ 25,1000 to $ 100,400 for a family of four. Income eligibility levels are expected to rise slightly for 2019; the new figures won’t be available until Nov. 1, 2018.

The lower your income, the higher the premium tax credit you’re eligible for (i.e. the help you’ll receive).

What Kind of Plans Are Available?

Insurers sell plans in four categories: Bronze (the least coverage and the lowest premiums), Silver, Gold and Platinum (the most coverage and the highest premiums). Depending on where you live, you may find several types of plans at each level.

You’ll want to make sure your doctors are in the plan you choose and that your prescription medications are covered.

You may have a choice of:

  • An exclusive provider organization (EPO), which covers services provided only by doctors and hospitals in a network, except in an emergency. You aren’t required to choose a primary care provider.
  • A health maintenance organization (HMO), which requires you to obtain care from doctors who work for or contract with the HMO, except in an emergency. You may have to live or work in the HMO service area.
  • A point of service plan (POS), which charges less if you use health care providers that belong to a network and requires you to get a referral from your primary care doctor to see a specialist.
  • A preferred provider organization (PPO), in which you pay less for in-network providers, but you can go to out-of-network providers for an additional fee. You don’t need a referral to go to a specialist.

Average unsubsidized premiums vary widely from state to state. The price of the Silver plan for a 27-year-old single nonsmoker ranges from a low of $ 278 per month in Indiana to $ 709 per month in Wyoming, according to the U.S. Centers for Medicare and Medicaid Services.

The figures apply only to the 39 states that use the HealthCare.gov platform. About 9 million people have coverage through those exchanges, according to the federal government.

Catastrophic Insurance

Catastrophic insurance is another alternative available to people younger than 30 and those who can claim a hardship exemption, such as homelessness, domestic violence or bankruptcy. You must apply for the exemption.

On the upside, catastrophic plans cover the 10 essential health benefits, offer specific preventive services for free and cover at least three visits to a doctor annually before the deductible is met. They also cost about one-third as much as more comprehensive plans.

The large downside is that the deductible — the amount the patient has to pay before the insurance company starts sharing the cost — is $ 7,900. Additionally, these policyholders aren’t eligible for a premium tax credit.

Kominski of UCLA suggests that consumers compare the coverage and cost of a lower-tier plan in the Marketplace before choosing a catastrophic plan.

Coverage That Doesn’t Meet Affordable Care Act Standards

As of Oct. 1, 2018, low-cost health policies became available for a one-year term, renewable for up to three years. Previously, they were sold for a three-month period of coverage only, and were considered stopgap insurance plans for people between jobs or otherwise temporarily without insurance.

It’s important to be aware that these policies don’t comply with the mandates of the Affordable Care Act, meaning they don’t have to cover people with pre-existing conditions or pay for any of the services the act deems essential.

Kominski warns that low-cost policies may seem attractive — until you need medical care. He compares them to a car that’s cheap, but only because it doesn’t have airbags or comply with air-quality standards.

“If you’re shopping for price, you’re going to get what you pay for,” he said. “If you want to expose yourself to risk, we can make health care really affordable.”

Susan Jacobson is an editor at The Penny Hoarder. She also writes about health and wellness. Follow her @SusanJacobson44.

The Penny Hoarder Promise: We provide accurate, reliable information. Here’s why you can trust us and how we make money.

This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.


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Readers And Tweeters: Are Millennials Killing The Primary Care Doctor?

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.


Health Care Wasted On The Young

I feel Sandra Boodman’s thesis is inadequate without a historical comparison to how young people accessed health care five, 10 or 20 years ago (“Spurred By Convenience, Millennials Often Spurn The ‘Family Doctor’ Model,” Oct. 9). As a family medicine doctor practicing for 33 years, my experience is that healthy young people use medical services only for urgent care and pregnancy until they develop chronic conditions. And, as a society in general, we have become more demanding about receiving services “now.”

Why should medical care not change as our expectations change? Certainly we have the technological ability to provide a portable health record one could take from site to site to improve continuity. We also have the ability to have a single electronic medical record or shared information hub so one’s health info can be accessed by any provider anywhere.

However, demanding “now” care at any convenient site does not allow one provider to get to know a person in a way to better inform them of how that individual’s situation (emotional-social-economic) impacts their health. So, convenience has its price.

— Dr. Kevin Walsh, Ellensburg, Wash.


Family physician Ajoy Kumar of Florida led a lively debate on Twitter and, in a series of tweets, emphasized how important it is to build doctor-patient relationships early because “nobody is young and healthy forever.”

— Dr. Ajoy Kumar, St. Petersburg, Fla.


It’s not so much the new generation as it is the age group. I didn’t have a primary care physician from the time I entered university until I was 42. I also only went to the doctor when I had a particular problem to deal with. Even back then (25-30 years ago), a $ 200 deductible meant I could pay for insurance but could not afford to use it for anything other than a dire emergency. Of course, back then almost everything was traditional indemnity, so we all paid full-freight unless you were covered by one of the nascent HMOs (which often controlled costs by denying care).

— Brenda F. Bell, North Plainfield, N.J.


Another primary care doctor bemoaned the trend as part of a larger move away from generalized medicine:

— Dr. Holly Mitchell, Amarillo, Texas


As long as we are talking about new models for medicine, here’s a plea for “human-centered design thinking”:

— Julie Schilz, Northglenn, Colo.


Laryngitis On The Campaign Trail?

It isn’t surprising that health care is a priority issue for voters (“Health Care Tops Guns, Economy As Voters’ Top Iissue,” Oct. 18). After all, the chief cause of personal bankruptcy is medical bills. Nor is it surprising that voters have not heard much about health care from midterm election candidates, who know the future success or failure of the health system and their political futures depend on how they respond to voters’ top concerns. It is much safer for our political leaders to leave the administration of the health system to the insurance companies.

But, so far, private insurers have shown they are more concerned with shareholders’ concerns than patients’. The result is a fragmented, impersonal health system overrun by multiple insurance plans, each with different copays, deductibles and insurance panels — where doctors are held captive by insurers’ regulations. If we vote people into office because we believe they will respond to our needs, why are so many of them so quiet on health care?

— Dr. Edward Volpintesta, Bethel, Conn.


Metrics Show Medicaid Is True To Its Mission

Both Medicaid enrollees and taxpayers see real results from Medicaid health plans — despite contrary claims (“As Billions In Tax Dollars Flow To Private Medicaid Plans, Who’s Minding The Store?” Oct. 19). Medicaid plans are held to high standards by the states, improving health, quality and savings for millions of Americans, including children, veterans, seniors and people with disabilities.

Medicaid plans run many programs to improve patient health — driving quality, coordinating care, and helping patients stay compliant with treatment. The vast majority of every Medicaid dollar pays for care, while Medicaid plan profit margins average less than 2 percent.

Medicaid plans report metrics that are made public. Results show that insurance providers saved states about $ 7 billion in 2016 alone — helping states realize the highest value for their Medicaid investment. Research shows that Medicaid enrollees have access to care that is similar to those who have coverage through their jobs, and are satisfied with their coverage.

Medicaid serves nearly 75 million Americans. Insurance providers know that Medicaid must work for those who rely on it — and the hardworking taxpayers who pay for it. We are committed to working together to ensure that Medicaid is effective, affordable and accountable.

— Matt Eyles, president and CEO of America’s Health Insurance Plans (AHIP), Washington, D.C.


A tweeter reading the same story noted the outsize level of Medicaid oversight compared with that of corporate America.

— Fran Quigley, Indianapolis


Imagine No Big Pharma

I know that we are all supposed to think the pharmaceutical industry is the savior of our country and that without them life itself would not be possible. What if we instead began to think of them as just the manufacturers of medication? What if we did our own drug research (maybe researching medication to treat millions instead of medication to make millions) and collected bids from every drug manufacturer for production only? What if we used tax dollars to pay for the manufacturing of the medications, and patients had to pay only a token pharmacy fee? I wonder what that would look like.

— Dr. David Herring, Staunton, Va.


Unamusing Cartoon

The publication by Kaiser Health News of a Nick Anderson cartoon with the caption “Inadequate Mental Health Services” above a picture of a prescription bottle reading “RX for Violence” from which bullets spill forth, is both surprising and deeply disappointing (‘Alternative Treatment’? Oct. 18).

How easy it is to imply that gun violence, indeed violence of any type, is largely attributable to untreated or undertreated, mental health conditions. But the facts, which I and millions of readers have come to expect from KHN, say otherwise. Mass shootings, the thought of which this cartoon invokes, account for less than 1 percent of gun violence, and for which mental health is a factor in but a small minority of cases. And while suicides are in fact increasing, and 85% of completed suicides involve guns, this too is only a small fraction (about 2%) of gun violence in the U.S.

It would be expected that KHN editors would be familiar with the oft-cited statistic that only about 4% of all violence may be attributed to people with serious mental illness, and the fact people with mental health conditions are far more likely to fall victim to violence than to perpetuate it against others.

As a trusted source of factual news, it is shocking that Kaiser would perpetuate and reinforce the erroneous, albeit widely held belief, that mental illness (treated or not) equates to gun violence.

— Debbie Plotnick, vice president for mental health and systems advocacy, Mental Health America, Alexandria, Va. 


I appreciate the perspective that inadequate mental health services can lead to negative consequences for the individual and, ultimately, for society. However, the implied connection between mental illness and violence is unfairly stigmatizing and not supported by evidence. In addition, the use of a prescription bottle seems to suggest that medication is the prescription for “adequate mental health services,” which vastly oversimplifies the need for a range of services that should be included in an effective, comprehensive system of care. I hope that you will consider removing this cartoon from your website, as it is harmful to engaging and truly supporting people with mental health needs.

— Jenifer Urff, Northampton, Mass.


A Call For Deeper Reporting

I was disappointed by Phil Galewitz’s reporting on the negative aspects of Medicare Advantage HMOs (“Medicare Advantage Plans Shift Their Financial Risk To Doctors,” Oct. 8), although it was nice that he quoted me and that you incorporated “risk shifting” into the headline. Galewitz cites a Health Affairs report but should have mentioned years of reports by the Government Accountability Office and the Medicare Advisory Payment Commission detailing overpayments and risk analysis and overpayments. There is a big dark side to Medicare Advantage plans that patients/consumers do not understand. They think it’s all about “free” care. It is hard to sue these HMOs for medical malpractice and failure to coordinate and manage care — which is what they promise to do. Medicare Advantage needs more critical reporting.

—Dr. Brant S. Mittler, San Antonio, Texas


For a Georgia reader, the story raised more questions:

— Colleen Mahaney, Woodstock, Ga.


On Shooting Down Sky-High Bills …

We in Montana were frustrated in our process to address the balance billing issues for air ambulance, with little success (“Will Congress Bring Sky-High Air Ambulance Bills Down To Earth?” Sept. 27). But the issue arises from insurance companies inserting a coverage cap in the policy, stacking deductibles for in- and out-of-network carriers. Much about this issue is aimed at air companies. They are solely responsible for their charge practices. But insurers also share the responsibility for their decisions to put those who are insured at risk as they seek to constrain premiums by policy design.

— Bob Olsen, Helena, Mont.


… And Missing The Mark?

The Oct. 19 Facebook Live broadcast (“Facebook Live: What About Those Sky-High Air Ambulance Bills?”) failed to note critical facts and provided misinformation. Alarmingly, this may cause patients to question whether they should board an air medical flight even when their physicians or first responder requests the transport based on patient need. We’d like to set the record straight.

1. Insurance Coverage

FACT: Dr. Naveed Kahn’s insurer’s payment was far lower than the actual bill, and air medical services, like all health care providers, are required by federal law to “balance bill” the patient the remainder. Dr. Kahn’s insurance company failed to adequately cover his bill.

[Editor’s note: KHN’s coverage did not focus on the mechanics of “balance billing,” but rather the prohibitive amount of the original bill.]

2. State Regulation

FACT: States can and do regulate air ambulances. Court decisions and Department of Transportation opinions have reaffirmed states’ authority to regulate all medical aspects of air medical transportation. This includes standards and coordination of patient care, including protocols controlling which air medical operator is called to a scene. Air medical operators never self-dispatch; they are called by trained first responders and medical personnel, operating under state authority.

3. Medicare Fee Schedule

FACT: The implementation of the Medicare Fee schedule did not increase rates for air ambulance services; it changed the way air ambulances are reimbursed, increasing the rates for some and dramatically decreasing the rates for others. While the data demonstrates the industry has grown over the last 37 years, according to “An Economic Analysis of the U.S. Rotary Wing Air Medical Transport Industry”, 22 of those growth years occurred before the implementation of the Medicare Fee Schedule.

Industry growth, over a 30-year period, reflects growth in demand for air medical transport services in response to continued closures of rural hospitals and trauma centers. Air ambulances are filling that gap — more aircraft means better coverage and better outcomes.

— Carter Johnson, SOAR (Save Our Air Medical Resources) Campaign, Washington, D.C.

Kaiser Health News

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Hate Erika Nardini? You’re not alone, and she couldn’t care less

Erika Nardini is the most controversial woman in sports media. As the CEO of Barstool Sports, she is the mama bear of a wildly popular comedy and sports Web site that prides itself on aggressively bucking political correctness — with a tone some have called ­misogynistic. Much of that swirls around the site’s founder, Dave…
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This bitter House race in New York shows how health care is dominating the battle for Congress

In swing districts such as New York's 19th, Democrats have tried to leverage health care to their advantage while taking care not to move too far to the left on the issue and open themselves to GOP attacks. 
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GOP Gubernatorial Candidate John Cox: Limit Government In Health Care

John Cox stood on a presidential debate stage and told the audience that he was glad abortion wasn’t legal in 1955.

If it had been, he said, he wouldn’t have been born.

“I wouldn’t be standing here before you today. This is personal to me,” Cox said in the 2007 GOP presidential primary debate, explaining that his biological father walked out on his mother.

“My mother took responsibility for me,” he said. “She’s glad she did, and I’m glad she did.”

Cox, California’s Republican candidate for governor, frequently invoked his anti-abortion views during his unsuccessful political bids for Congress and president. He unapologetically framed himself as the anti-abortion candidate – a Christian who believes in the right to life, and whose “absolute opposition to abortion on demand” was born from his mother’s circumstances.

Cox has been less vocal about his abortion views in blue-state California, where Republicans, Democrats and independents overwhelmingly favor a woman’s right to choose. But his argument that it is an issue of personal responsibility provides a window into Cox’s thinking when it comes to health care overall: He contends that free markets, combined with people taking responsibility for their actions, ought to guide health care policy — and that government should mostly stay out of it.

His views on health care contrast starkly with those of the Democratic gubernatorial nominee, Lt. Gov. Gavin Newsom, who calls for health care coverage for all Californians, and supports the creation of a single-payer, government-run health care system financed by taxpayers. In the latest Public Policy Institute of California poll released in late September, Cox trailed Newsom by 12 percentage points among California’s likely voters, with 7 percent undecided.

As a candidate for governor, Cox has not released detailed health care positions. Nor would he agree to an interview with California Healthline to explain his views or allow those closest to him to comment.

On Monday, with less than a month before the election, Cox issued a statement following a live gubernatorial debate saying that he supports affordable health care for everyone, including those with preexisting conditions. He again failed to provide any specifics.

A review of his statements, old and current campaign websites, and interviews with previous campaign aides portrays a successful businessman who believes in limiting government in health care and in general — a political philosophy inspired by Jack Kemp’s focus on free enterprise, fiscal conservatism and family values during the 1988 presidential campaign.

Cox, who grew up in a Chicago suburb he describes as lower-middle class, became a successful tax attorney, investor and developer before getting involved in Illinois Republican politics. He didn’t do as well in that arena: He ran unsuccessfully for Congress — the House in 2000 and the Senate in 2002 — and for Cook County Recorder of Deeds in 2004 and president in 2008.

“John is a principled guy. He didn’t come from much and he did very well,” said Nicholas Tyszka, who was Cox’s campaign manager in his U.S. Senate bid. “He’s certainly more of a limited-government guy who believes if you give people an opportunity to do good things, they will.”

Cox, 63, settled in California permanently in 2011, and now lives in the affluent San Diego suburb of Rancho Santa Fe.

He has spent much of his campaign lamenting California’s high cost of living, along with the recent gas tax increase that he is encouraging voters to repeal in November.

Cox’s mindset of limited government, combined with his conviction of personal responsibility, feeds his argument that competition is the answer to rising health care costs, high prescription drug prices and nurse shortages.

“I’ve heard him say many times health care should be run more by the free markets and the federal government should have less involvement,” said Phil Collins, a Republican county treasurer candidate in Nevada who worked on two of Cox’s campaigns in Illinois.

In Monday’s statement, Cox complained that “our current system was designed by political insiders and health care corporate lobbyists to protect their monopoly profits, not to provide decent health care at a reasonable price.”

Cox said previously that, if elected governor, he isn’t interested in defending the Affordable Care Act, and that if Congress and the Trump administration were to repeal the law, the millions of Californians who now have coverage could go into high-risk insurance pools. That could increase the ranks of the uninsured.

In the hour-long debate Monday hosted by KQED, a San Francisco National Public Radio affiliate, Newsom challenged Cox’s desire to repeal the ACA and criticized his abortion views when asked how the confirmation of Brett Kavanaugh to the U.S. Supreme Court could affect California.

“It could have a profound impact on Californians, on their reproductive rights, which you believe a woman does not have a right to choose, regardless whether or not they are raped or a tragic incident of incest,” Newsom said.

Cox, who has dodged questions about his views on abortion during the gubernatorial campaign, did so again during the debate, saying only that he would appoint justices in California who will respect the U.S. and state constitutions.

“The things I’ve seen him say are very much aligned with what we hear coming out of the Trump administration and the Republican leadership of Congress,” said Dr. Andy Bindman, a primary care doctor at Zuckerberg San Francisco General Hospital and professor at the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco who helped draft the Affordable Care Act.

When the state legislature this year considered bills that would have opened Medi-Cal, California’s Medicaid program, to unauthorized immigrants between ages 19 and 25, as well as those 65 and older, Cox went on national television to call the Democratic plans a “freebie” and told Fox News that “our government has been grabbed by a bunch of people who believe that government is the most important thing.” The bills died in the legislature.

Cox has also criticized Newsom for advocating both a single-payer system, which he says would destroy California’s economy, and health coverage for unauthorized immigrants.

“Gavin Newsom wants to make problems even worse, by increasing the costs of health care of Californians and then rewarding those who cut in line,” Cox said in an August news release. “If we want to see how Newsom’s government health care would work, just look at the DMV.”

If elected governor, Cox said in his post-debate statement, he “will break up the health care corporate monopolies, make insurance companies compete and turn patients into consumers with power over their health care dollars.”

He declined to provide any details in response to questions submitted to his campaign.

Bindman said Cox is taking a page out of the national Republican playbook — bash the Affordable Care Act without offering solutions.

“John Cox is not talking a lot about health care other than saying what he’s against because he doesn’t have any viable alternatives that ensure people retain coverage,” Bindman said.

But over the years, Cox has made suggestions that display his confidence in free markets to solve problems. What exists now, he argued in his 2006 book, “Politic$ , Inc.,” is an “illogical system” where insurance companies and government have taken over individual patient care.

The solution, Cox argued both in his book and on his website as a presidential candidate, would be to end the federal tax deduction for employee health insurance, opening the door to more competition and lower prices. Like auto insurance, consumers ought to be able to choose their own health insurance plans in a free market, he said.

The poor could benefit from a limited government voucher program, he proposed, one with incentives to save money and get preventive care, as well as health savings accounts that encourage consumers to find care at the most reasonable cost.

“Wealthier people may well have better choices, but that should be one of the awards for upward mobility,” he wrote.


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

Kaiser Health News

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Women in Kenya Want Access to Quality Maternal Health Care

what women want in kenya

In April 2018, hundreds of partners joined forces to launch What Women Want, a global campaign to hear directly from one million women and girls about their top request for quality reproductive and maternal healthcare services. Through an exclusive blog series, Ms. is sharing their demands and their stories. 

The What Women Want campaign aims to amplify women’s demands for quality reproductive and maternal health care around the world. Translated into more than 14 languages, the campaign strives to hear from women from all backgrounds, cultures and locations—and has partnered with over 300 global organizations that support and empower women with HIV, women with disabilities and health professionals in over 100 countries to make that possible.

Recently, What Women Want heard from thousands of women in Kenya about their top request for quality reproductive and maternal health care. Here’s what they have to say.

According to the Partnership for Maternal and Child Health, the maternal mortality rate in Kenya remains high, at 488 maternal deaths per 100,000 live births. (For reference, the maternal mortality rate in the United States is 26.4 per 100,000 live births, which is still lacking when compared to peer nations.)

We know that nearly all maternal deaths are preventable. Significant disparities in maternal mortality rates tell us that programming efforts and advocacy work must be adjusted to reach women everywhere—not just in the world’s richest countries, and not just in major cities.

Accessibility to quality health care centers is a major issue that contributes to high maternal mortality rates in Kenya. Around half of Kenyan women are delivering in health care facilities, and only 44 percent are assisted by a skilled medical professional.

Since 1990, the global maternal death rate has decreased by 44 percent, and more women than ever are using maternal healthcare services—but much of this progress was achieved in high-income areas, leaving some countries with little or no improvement. Today, 99 percent of maternal deaths take place in developing countries—with just 13 countries accounting for two-thirds of these deaths.

Within countries with high maternal mortality rates, there are significant disparities in maternal mortality and maternal healthcare utilization. In Sub-Saharan Africa, for example, the utilization of prenatal, delivery and postnatal care varies greatly with personal characteristics such as geographic region, race, income level, employment and marital status.

Progress is being made, and we should be encouraged by the monumental decreases in maternal mortality and increased access to reproductive health care, but it isn’t enoughWe need to strive for more.

We must listen to the voices of those who are too often left behind. When we can raise the voices of women in every part the world, we will be closer to a time in which every woman, everywhere, is empowered to speak out and closer to receiving quality, equitable maternal and reproductive health care.

Join the one million women mobilizing for global change by adding your voice at www.whatwomanwant.org.

Claire McGee is a sophomore at Ohio University in Athens, Ohio studying Public Health and Spanish. She spent this past summer as a Communications, Fundraising and Respectful Maternity Care Intern for the White Ribbon Alliance in Washington, D.C.

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The post Women in Kenya Want Access to Quality Maternal Health Care appeared first on Ms. Magazine Blog.

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9 Fall Skin Care Rules Dermatologists Want You to Follow

Now that fall is here, it’s a good time to start thinking about tweaking your skin care regimen, as cold, drier air usually calls for lots of moisture and a little less exfoliation. If you aren’t sure about which crucial steps of your routine you should actually ditch or keep, we asked experts to share some helpful skin care dos and don’ts to consider before winter arrives. Here are 9 fall skin care tips and tricks you’ll definitely want to keep in mind.

[ Next: Skin Care Sticks Are a Lazy Girl’s Dream ]

 

This article originally appeared on TotalBeauty.com

The post 9 Fall Skin Care Rules Dermatologists Want You to Follow appeared first on theFashionSpot.

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‘I want to show them that I don’t care’: Melania details life in the White House

Melania Trump, maybe America’s most private first lady ever, opens up in an exclusive interview with ABC News.
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Tevin Campbell Doesn’t Care If You Call Him Gay Because He Can Sing: “Y’all Homophobes Gotta Do Better”

2015 Soul Train Music Awards - Arrivals

Source: Earl Gibson/BET / Getty

via MadameNoire:

Tevin Campbell may not have released a new studio album since 1999, but the 41-year-old is still considered a beloved musical figure. However, that hasn’t kept the trolls of today’s social media culture from persistently trying to paint Campbell a certain way.

There have been questions about drug use, rumors that he’s been a victim of molestation, and all sorts of comments about his sexuality. Whether or not he was gay became a big question following his arrest for soliciting oral sex from an undercover policeman in 1999. When it comes to his sexuality, the “I’m Ready” singer decided to let folks know this week, after being weary of ugly comments about it, that no matter what they say, it doesn’t matter. He can still sing circles around your faves.

“Y’all homophobes gotta do better,” he wrote on Twitter. “The thing you will never ever be able to say about me is ‘that boy can’t sing.’ That’s the day I will be sitting at home crying and that day will be never.”

Campbell has spoken about his sexuality in the past. During an interview with former publication Sister 2 Sister, he told Jamie Foster Brown that he’s “try-sexual,” which is a way of saying he’s “open-minded.”

“I’m not gay, but there’s a lot of different things that I do like, sexually,” he said. “Being in the business, you are introduced to a lot of different things. I’m not gay, but I’m a freak and I think a lot of people know what a freak is.”

He also told IMissTheOldSchool back in 2009 that his sexuality shouldn’t be of concern to others.

“That’s nobody’s business. If someone is interested in me and they wanna be my friend or whatever, then we can talk. It’s nobody’s business what I like to do behind closed doors, just because I am a celebrity,” he said. “I hate that. And I like the fact that people wanna know. Let ‘em wonder. I like to leave a little bit to the imagination. But if you happen to get to know me and we hit it off… I share a lot of personal things with friends, which is a normal thing to do.”

After Thursday’s tweet, the real question is…when are we getting some new music, Tevin?!

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11 Pumpkin Skin Care Products That’ll Brighten Your Complexion for Fall

Pumpkin is so much more than an autumnal treat found in lattes. The orange gourd is actually rich in alpha hydroxy acids, which help exfoliate and renew the skin, say dermatologists. Here, we’ve rounded up 11 pumpkin-infused skin-care products to use for brighter skin this fall.
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Viewpoints: Trump Says ‘Medicare For All’ Plan Would Eventually Lead To Massive Rationing Of Health Care

President Donald Trump writes about his views on the Democrats’ “Medicare For All” plan, which has become a litmus test among progressive candidates. Editorial pages look at other health issues, as well.
Kaiser Health News

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Students Across California Want Abortion Care on Campus—And They’re Not Done Fighting for It

California Governor Jerry Brown last week vetoed a popular measure that would have expanded abortion access for college students across the state.

Nearly three years ago, students at the University of California in Berkeley began fighting for better access to abortion on campus. The student government ultimately passed a resolution endorsing their call for on-campus medication abortion access, but administrators then failed to act on their demands—so students turned to local lawmakers. 

California’s College Student Right to Access Act, known in the legislature as SB 320, was written by three reproductive justice activists from UC Berkeley. The measure, introduced by state Senator Connie Leyva, passed through the state legislature with overwhelming support. A group of donors even came forward willing to fund its mandate: on-campus medication abortion access for all public college students in the Golden State intending to terminate a pregnancy in the first 10 weeks.

But the fierce and proactive attempt to expand women’s reproductive rights was stopped in its tracks by one man who deemed it inconsequential: Last Monday, Jerry Brown vetoed the act, calling it “not necessary.”

But just because Governor Brown was never in need of abortion care on campus doesn’t mean no one else is. More than 500 students in the UC and California State University systems seek out abortions monthly, and these students would have a much easier time getting the care they need if their university health centers had the means to offer it. Many students have to travel far distances to get to appointments, and, for a medical abortion, usually need to make it to at least two appointments.

Costs go up with every additional hurdle put in front of women seeking abortions—which was the case fo Jessy Rosales, who opened up to Huffington Post about her own off-campus abortion at 20: 

Jessy Rosales was a 20-year-old student at the University of California, Riverside, when she got pregnant. She had used protection and was not ready to become a mom, so she went to her campus health center to ask about the abortion pill—actually a combination of two medications that can safely end a pregnancy.

She left with a list of recommended providers. But the first clinic she called told her it did not perform abortions. And the second was a crisis pregnancy center—a facility that seeks to dissuade women from having abortions.

“I’m a first-generation student. For a large majority of my life, my parents didn’t have health insurance, so I didn’t really know what I was doing trying to navigate through the medical system,” Rosales, now 22, recalled in a conversation with HuffPost.

Finally, more than two months after her positive pregnancy test, she went to a nearby Planned Parenthood health center, where she was able to get an in-clinic abortion. It cost her roughly $ 400—a lot of money for a student supporting herself with part-time work and federal loans—and she was told she was too far along to be a candidate for the abortion pill at that point. (It must be taken before 10 weeks of gestation.)

“Had they provided abortion medication on my campus, I would have been able to get the care I needed when I needed it,” Rosales said.

Two-thirds of UC students and one-third of CSU students don’t own a car; 62 percent of them also live 30 minutes or more from a clinic. Often, these clinics are not open on the weekend, which only adds to their burden. 

Going through with a legal and time-sensitive medical procedure shouldn’t take that much work. Seizing an opportunity to ease the process of managing an unwanted pregnancy is far from “not necessary” for the students who must arrange transportation, cover costs, miss class or skip work to make it possible to access the care they need.

“Governor Jerry Brown, on his own, determined what was a legitimate burden in accessing abortion and neglected the experiences of countless students who explained the obstacles and burdens they faced when making a reproductive health decision as a California public university student,” Adiba Khan, one of the students who led the fight for SB 320, told Ms. “To get elected, he has expressed he is ‘pro-choice,’ but then when given the chance to expand access, to what he has repetitively claimed he believes is a right, he vetoes it. This is the behavior of a coward. He has disappointed thousands of students and denied them better agency over their futures.”

Students from across California joined in Khan’s frustration, taking to social media to slam Brown for his decision after news broke that he was vetoing the legislation.

Advocates and activists from across the country also weighed in, showing solidarity with the students who made SB 320 possible and calling on Brown and other lawmakers to do better by the women they serve.

“At its core, SB 320 affirmed the constitutional right of college students to access abortion care promptly and without delay,” Senator Leyva wrote in a statement. “As the Trump Administration continues to unravel many of the critical health care protections and services for women, legislation such as this is urgently needed to make sure that Californians are able to access the full range of reproductive care regardless of where they may live.”

She also vowed to continue fighting. “In the months and years ahead,” she declared, “I will continue fighting to make sure that college students have access to medication abortion on college campuses. I am hopeful that our incoming Legislature and Governor will agree that the right to choose isn’t just a slogan, but rather a commitment to improving true access to abortion for students across California.”

Miranda Martin is a feminist writer and activist and an editorial intern at Ms. She has written for a variety of publications and been published by The Unedit and Project Consent. Miranda recently graduated from University of Wisconsin La Crosse with a major in Interpersonal Communications and a double minor in Creative Writing and Women, Gender and Sexuality Studies. She loves to travel, read, exercise and daydream about the fall of the patriarchy.

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The post Students Across California Want Abortion Care on Campus—And They’re Not Done Fighting for It appeared first on Ms. Magazine Blog.

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The Latest Thing Millennials Are Killing? The Primary Care Doctor

Millennials are killing everything from car ownership to home ownership to beer to vacations to the institution of marriage itself, if the headlines are to be believed. (Full disclosure: I am a millennial.) So why not add another victim to the list? In this case, the primary care doctor.

A Kaiser Family Foundation (KFF) survey and followup analysis by Kaiser Health News found that 26% of 1,200 respondents said they didn’t have a go-to primary care physician. But, digging a bit deeper, the survey found sharp generational shifts fueling that trend: Nearly half (45%) of 18-to-29 year olds said they didn’t have a primary care doctor. That figure fell to 28% for Americans aged 30 to 49 and just 18% and 12%, respectively, for people in the 50-to-64 and 65-plus cohort.

Some of this can likely be explained by a divergence of needs. It’s not implausible to think that, the older you get, the more you may want to have the security of a personal medical professional versed in your health history.

But it also represents a sea change in thinking likely fostered by an increased emphasis on convenience (and, perhaps, increasingly transitory lifestyles), according to some experts. A same-day telehealth appointment in a stranger could prove more valuable to some than a long-standing relationship with a doctor who may not be available at the click of a button.

The broader question is: What long-term effects will this shift have on public health? People with chronic conditions, for instance, may benefit from the stability of a primary care doctor who can provide continuous (and, theoretically, more personalized) care. At the same time, Americans who live in the numerous areas with a shortage of doctors may have entirely understandable reasons for pursuing more transitory medical relationships.

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New Study Finds Health Care Costs Are Rising Almost Twice as Fast as Wages

If you’ve noticed an increasingly bigger chunk is coming out of your paycheck for medical premiums and deductibles, you’re not alone, according to a newly released survey.

In 2018, the cost of premiums has outpaced raises and inflation, the Kaiser Family Foundation’s Employer Health Benefits Survey found.

The 20th annual survey looked at cost trends for the 152 million Americans who are covered by health insurance — almost half of the population.

Together, employers and employees now spend $ 19,616 annually on coverage per family, while single coverage costs $ 6,896, according to the foundation.

From 2006 to 2012, premiums rose 37%, while salaries increased only 18%.

Who’s Affected Most by Rising Health Care Costs?

“Rising health care costs absolutely remain a burden for employers, but they’re a bigger problem for workers as their cost sharing has been rising really much faster than their wages have been rising in recent years,” said Drew Altman, president and CEO of the Kaiser Family Foundation.

Average family premiums increased 5% in the past year, while singles paid 3% more. Meanwhile, wages outpaced inflation by just 0.1%, according to the report.

In general, employees at smaller companies shoulder a larger percentage of premiums and deductibles than their counterparts at bigger firms, Altman said. Average deductibles were $ 2,132 at small firms versus $ 1,355 at large employers (200 employees or more).

The cost paid for deductibles rose 212% over the past decade — eight times the growth of wages, he said.

On the upside for smaller firms, 27% of employees’ entire premium costs are employer-paid, versus 6% of employees at large companies, according to the report.

How Much Are We Paying for Health Care Each Year?

The average premium amount contributed by all workers is $ 1,186 for a single person and $ 5,547 for a family. Although that’s about the same as last year, the average amount for family coverage has increased 21% since 2013 and 65% since 2008, Kaiser found.

Most workers also are responsible for copayments when they go to a doctor’s appointment. The average is $ 25 for primary care and $ 40 for specialists, Kaiser calculated. Many workers also pay coinsurance of 18% of the covered amount of each visit, whether to a primary-care doctor or a specialist. (That was about the same as in 2017.)

Kaiser officials said employees should read their companies’ websites carefully to determine the most cost-effective option, although they acknowledge that the choices may not be plentiful.

“When you can, you should shop around,” Altman said.

Susan Jacobson is an editor for The Penny Hoarder. She also writes about health and wellness.

The Penny Hoarder Promise: We provide accurate, reliable information. Here’s why you can trust us and how we make money.

This was originally published on The Penny Hoarder, which helps millions of readers worldwide earn and save money by sharing unique job opportunities, personal stories, freebies and more. The Inc. 5000 ranked The Penny Hoarder as the fastest-growing private media company in the U.S. in 2017.


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Kaiser Permanente and the Alliance of Health Care Unions Reach Tentative Labor Agreement

LOS ANGELES — Kaiser Permanente and the Alliance of Health Care Unions have reached a Tentative Agreement on a national, 3-year collective bargaining agreement that covers nearly 48,000 unionized Kaiser Permanente health care workers in 22 union locals.

The negotiations, which began in May, were among the largest private-sector contract talks in the United States this year. The deputy director and commissioners of the Federal Mediation and Conciliation Service attended the sessions. The tentative agreement was reached on September 23.

Read the Federal Mediation and Conciliation Service’s statement acknowledging Kaiser Permanente and the Alliance of Health Care Unions for their “exceptional achievement” in reaching a tentative agreement.

The Tentative Agreement goes far beyond the traditional contract issues of wages and benefits. It includes provisions to strengthen the groundbreaking labor-management partnership between Kaiser Permanente and the Alliance, at the senior leadership level as well as the front-line level. This includes 3,600 unit-based teams — jointly led by pairs of managers and union-represented employees — that are delivering significant improvements in the areas of quality, affordability, service and work environment on behalf of Kaiser Permanente members and patients.

The Tentative Agreement also offers enhanced career development programs to enable Kaiser Permanente’s workforce to continue meeting member needs in an evolving health care environment.

“This agreement advances our ability to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve,” said Chuck Columbus, Kaiser Permanente senior vice president and chief Human Resources officer. “We’re proud of the skilled, dedicated and compassionate people of Kaiser Permanente who are devoted to our mission, our members and patients, communities and each other.”

“Our unions are committed to raising the standards of health care delivery, and the living standards of workers everywhere,” said Alliance Executive Board Chair Kathleen Theobald, executive director of the Kaiser Permanente Nurse Anesthetists Association. “We have shown that we can deliver top quality care hand in hand with industry-leading wages and benefits. This Tentative Agreement strengthens our partnership and our ability to keep delivering improvement for patients and workers.”

The agreement also reaffirms both parties’ commitment to working together under a new Labor Management Partnership agreement. The original agreement, reached in 1997, provided a joint strategy for organizational innovation and change, created an environment of continuous learning and improvement, and actively involved the workforce in decision-making. The new agreement builds on that, strengthening the commitment that Kaiser Permanente and the partner unions will promote each other’s mutual success.

The new Tentative Agreement includes:

  • Across-the-board wage increases, which vary by region and by year.
  • Enhanced processes to re-energize the Labor Management Partnership and ensure the engagement of senior leaders.
  • A new labor-management trust to fund the partnership with the Alliance.
  • A new educational trust to fund job training, pursuit of academic degrees, professional certification and career counseling services for employees represented by an Alliance union.
  • Continued support for 3,600 front-line teams. Worker engagement and participation in these teams have helped Kaiser Permanente garner recognition for clinical quality, patient safety and member satisfaction from organizations such as the Centers for Medicare and Medicaid Services and the National Committee for Quality Assurance.

The Tentative Agreement was unanimously approved by an Alliance bargaining delegate conference September 29 and will now go to union members for ratification. The voting is expected to be complete by the end of October. A senior Kaiser Permanente leadership group must also give its formal approval. If ratified, the agreement will have a retroactive effective date of October 1, 2018.

The contract will cover nearly 48,000 health care workers: 32,100 workers in California; 6,300 in Oregon and Washington; 2,100 in Colorado; 2,200 in Maryland, Washington, D.C. and northern Virginia; 2,800 in Georgia; and 1,900 in Hawaii. The workers span job classifications from registered nurses and pharmacists to maintenance and service workers.


About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

The post Kaiser Permanente and the Alliance of Health Care Unions Reach Tentative Labor Agreement appeared first on Kaiser Permanente.

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Kaiser Permanente Hawaii Awards $119,000 in Grants to Support Health Care Workforce and Economic Development

HONOLULU — Kaiser Permanente Hawaii has awarded $ 119,000 in community benefit grant funding to three nonprofits seeking to promote economic opportunity and support workforce development throughout the state.

“Kaiser Permanente is committed to addressing the shortage of health care workers and promoting economic opportunities in Hawaii,” said Dave Underriner, president of Kaiser Foundation Health Plan and Hospitals, Hawaii Region. “Supporting Hawaii’s health care sector, and helping small businesses grow and create jobs are among many ways we are committed to a thriving Hawaii.”

Hawaii Community College (via UH Foundation) was awarded $ 69,333 for the school’s nursing program to help address health care labor shortages on Hawaii Island. Ninety percent of the school’s nursing graduates — approximately 40 students per year — go on to work in health care positions on Hawaii Island, addressing a critical need for care providers in rural areas. The grant will be used to purchase a simulation mannequin that provides essential clinical education and hands-on skills learning to maintain accreditation for the nursing program.

Patsy T. Mink Center for Business and Leadership, in partnership with Mana Up (via YWCA Oahu), received $ 35,000 to promote economic opportunity, counseling and training for locally owned small businesses, with a specific focus on women’s leadership development. The nonprofits will offer a 10-month professional development course for 11 emerging women leaders, as well as a 12-week accelerator program for 20 local small businesses.

Hawaii Hospital Education and Research Foundation received $ 15,000 to expand scholarships for health care students in Hawaii. A shortage of providers in primary care, specialty care, mental health and oral health care, especially on neighbor islands, affects the health of the entire state. HHERF plans to offer scholarships ranging from $ 500 to $ 2,000 to 15 or more Hawaii health care students pursuing degrees in nursing, medicine, physical and occupational therapy, certified nursing assistant, medical assistant, pharmacy and health care IT.

About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, Kaiser Permanente has a mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 12.2 million members in eight states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal Permanente Medical Group physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/share.

The post Kaiser Permanente Hawaii Awards $ 119,000 in Grants to Support Health Care Workforce and Economic Development appeared first on Kaiser Permanente.

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Athletics find fan doused by beer, to send him care package

The 7-2 loss Oakland suffered in the AL wild-card game against the Yankees might sting for some time, but for one Athletics fan, the stink will soon go away. After loyal Oakland fan John Spencer was caught on video being doused with beer and pelted with a cup at Yankee Stadium on Wednesday night, the A’s wanted to make it right by sending him a care package "that doesn’t smell like beer." Despite the intentions of the Yankees fan, Spencer kept his cool and took it in stride. But the A’s didn’t know who the fan was or how to find him, so they did what you do these days — they started a manhunt Thursday on Twitter. Less than an hour later, they had found their man — Spencer, an Oakland native and current New York resident who was wearing an Eric Chavez jersey at the game. Spencer, who had tweeted Thursday that he had "met plenty of awesome yankee fans too," will be getting new A’s gear from the team,…
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Nurseries may trump informal or childminder care for kids’ psychological development

Attendance at a nursery/crèche staffed by professionals may be linked to better psychological development than being looked after by family/friends or a childminder in early childhood, suggests new research.
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