Health Care and FSAs in the New Health World

This article was originally published by Benefits Selling Magazine online on September 23, 2010. Thanks to them for promoting the material.

With all the new health care legislation passed this year, many are wondering how flexible spending accounts will be affected. According to AlanHaft.com, the new health care reform legislation impacts flexible FSAs in the way over-the-counter medications are handled and increases taxes on nonqualified distributions.
Beginning in 2011, FSAs cannot make reimbursements for the cost of over-the-counter medications, such as nonprescription pain relievers, cold medicines, antacids and allergy medications. However, insulin and over-the-counter medications prescribed by a physician will still be reimbursable on a tax-favored basis by these plans. You may want to stock up on your over-the-counter drugs to take advantage of the available reimbursement before the end of this year.

The IRS also resolved uncertainty involving the new over-the-counter restriction on what are known as “grace period” FSAs. Under rules the IRS issued in 2005, unused contributions made to FSAs in the current year can be rolled over to pay for expenses incurred during the first two and a half months in the following year. The new IRS rules say over-the-counter reimbursements are banned for grace-period FSAs and FSAs without grace periods effective January 1, 2011. Congress imposed the new limits to raise revenue to help pay for other provisions in the reform law that expand coverage, such as new federal insurance premium subsidies for the lower-income uninsured, beginning in 2014.

If you participate in an FSA as part of a cafeteria plan, beginning in 2013, the annual amount available for reimbursement for qualified medical expenses is limited to $2,500. This figure is adjusted for inflation in subsequent years, and the reduction does not apply to health FSAs that aren’t part of a cafeteria plan.

And, to cap off the new FSA regulations, you need to know the fine print in the new law, according to Wolters Kluwer. Effective for tax years beginning after Dec. 31, 2012, a health FSA is not a qualified benefit under a cafeteria plan, unless the plan provides for a $2,500 maximum annual salary reduction contribution to the FSA. If the plan does not specifically prohibit salary reductions in excess of $2,500, the benefit under the health FSA is not qualified.

Under such circumstances, an employee is subject to tax on distributions from the health FSA, thereby, eliminating any of the tax benefits of health FSA contributions, including those under $2500. There is a silver lining to the new limitation in that it protects employees from large forfeitures and protects employers from employees who game the system by signing up for large amounts, submitting large claims early in the year and then terminating employment, leaving the employer stuck with the bill.

And there are state tax consequences. The limitation of FSA contributions to $2,500 for tax years after 2012 does not impact states that conform to the federal exclusion by the time the provision takes effect. Because most states start their tax calculations with federal adjustable gross income, there should be no impact on those states. States that do not conform may allow an exclusion from taxation for amounts above the federal limitation, as well. Effective for tax years beginning after December 31, 2013, the $2,500 limitation is adjusted annually for inflation. Any inflation adjustment that is not a multiple of $50 is rounded down to the next lowest multiple of $50.

Until next time. Let me know what you think.

Health Care and 9/11--Nine Years Later

On a bright, sunny day on September 11,2001, just a short nine years ago, the world changed forever at 8:46 a.m. Eastern Time when the first of four passenger planes were highjacked by terrorists. According to 911Timeline.net, American Airlines Flight 11 impacts the north side of the North Tower (1 World Trade Center) of the WTC between the 94th and 98th floors. American Airlines Flight 11 was flying at a speed of 490 miles per hour (MPH), killing everyone on board. Minutes later, at 9:02:54 a.m., United Airlines Flight 175 impacts the south side of the South Tower of the WTC between the 78th and 84th floors at a speed of over 500 MPH, killing everyone on board. Parts of the plane including an engine leave the building from its north side, to be found on the ground up to six blocks away.

According to 911Timeline.net, what happened next was another horrific scenario taking place in Washington, DC, only a few minutes later. At 9:37 a.m., American Airlines Flight 77 is lost from radar screens and impacts the western side of the Pentagon, erupting in a huge fire ball and killing everyone on board. The section of the Pentagon hit consists mainly of newly renovated, unoccupied offices. Next, the unthinkable happens. At 9:59:04 a.m., the south tower of the World Trade Center suddenly collapses, plummeting into the streets below. A massive cloud of dust and debris quickly fills lower Manhattan. Several hundred miles away over the verdant green pastures in Southwestern Pennsylvania, another tragedy in this ongoing story is about to happen. About four minutes after the first collapse of the Twin Towers in New York, at 10:03 a.m., according to the FBI, the cockpit voice recorder stops and United Airlines Flight 93 crashes near Shanksville, Pennsylvania, in Somerset County, about 80 miles southeast of Pittsburgh.

Now, finally, as inconceivable as it was incredible the final blow happens only a short few minutes after the fourth airliner is down. At 10:28 a.m., the North Tower of the World Trade Center collapses. As the world watches in stunned amazement and disbelief, the lives of over 3,000 individuals had been snuffed out like a candle by the worst terrorist attack ever to take place on American soil. Over and over and over all day long, the images of these tragic events were played by every TV station on the planet while Americans sat in utter horror and despair. What had happened? How could this have taken place, and who was responsible? What would the nation do to recover? Questions lingered for days and weeks like the heavy smoke over the debris in lower Manhattan.

Since those events took place, America has been in a protracted war on terror against enemies both foreign and domestic. The lives of thousands of service men and women have been lost in the conflict, but the health of the nation they protect has been kept secure. However, the health of individuals affected by 9/11 has been studied over the past nine years has had some significant medical implications for those who were involved. According to NYC.gov, more than 400 New York City firefighters and police officers lost their lives as a result of the terrorist attack on the World Trade Center (WTC). Many other people at the scene that day and in the weeks that followed also witnessed horrific events at close range, including the loss of colleagues and the gruesome recovery and removal of body parts. In addition, more than 91,000 rescue, recovery and clean-up workers, and volunteers—including virtually all of the Fire Department of New York (FDNY)—were exposed to the environmental hazards at Ground Zero during their work on “the pile” and at other WTC-related locations in the days and months that followed.

Nearly 4 percent of the 25,000 rescue and recovery workers enrolled in the World Trade Center Health Registry report developing asthma after working at the WTC site according to a survey conducted in 2003 and 2004, according to NYC.gov. This rate is higher than what normally would be expected for the adult population during such a time period. Analysis of survey data indicated that arriving soon after the buildings collapsed, or working on the WTC pile over a long period, increased the workers’ risk of developing asthma. Workers who arrived on September 11, 2001, and worked more than 90 days reported the highest rate of new asthma (7%). FDNY members, nearly all of whom responded to Ground Zero within the first week of the attacks, suffered the most intense degree of exposure to the toxic mix of dust and chemicals at Ground Zero.

On September 11, 2001, approximately 25,000 children were living or attending school in lower Manhattan, some in close proximity to the WTC, according to NYC.gov. Within hours of the disaster, the New York City Board of Education provided principals and teachers with guidance on addressing the immediate needs of students. The Board recognized, however, that children in public schools needed immediate, expanded mental health services—including grief counseling, early intervention for post-traumatic stress disorder, and assistance managing fear, anxiety and anger—that could not be provided by the existing staff of school-based mental health professionals. Additionally, more than 400,000 people were in lower Manhattan the morning of 9/11, including thousands of office workers, small business owners, city employees, visitors and others. They fled at different times after the attacks. Some found their offices and stores buried under dust and debris when they returned. Others worked for months where the dust was less visible. Because of different exposures, it has been more difficult to determine how this group’s health was affected by 9/11.

According to MedicalNewsToday.com, since the 9/11 event, a cough has been developed by people working at and near ground zero. They thought the cough would eventually go away - unfortunately, they have intensified and the number of victims is growing. It seems the cause of these respiratory conditions is simply being in or near the area where the buildings collapsed. The scale of the consequence of breathing in the asbestos-laden dust is still unclear, although the complaints are in the thousands of individuals, including several thousand firefighters with various respiratory complaints. Not only was there asbestos in the air. There was lead from smashed computers as well.

According to Mesotheliomasos.com, first responders and New York City residents are now dying of mesothelioma and being sickened with other asbestos-related disease. Doctors and scientists have long predicted that, in years to come, the nation would be seeing an onslaught of mesothelioma cases in greater New York City, caused by the tons of asbestos that rained down on fire fighters, police officers, paramedics, and those who lived and worked near the World Trade Center. At the time of the disaster and for some time afterwards, most of Lower Manhattan was covered with a grayish dust--what’s been reported as a frightening combination of substances such as glass shards, asbestos, fiberglass, pulverized concrete, lead, mercury, cadmium, dioxins, and PCB’s. Many first responders suffered almost immediate health problems, and those who’ve studied the potential hazard of asbestos caused by the collapse of the World Trade Center estimate that more than 110,000 people may have suffered serious exposure. These same reports show that in the haste to clean up the debris, proper precautions were not taken to protect workers from harm nor were standard and necessary asbestos abatement procedures followed. This resulted in even more exposure.

Currently, Congress is debating health care legislation that will help to compensate these victims of 9/11, especially in the collapse of the WTC towers in New York. Although the events were tragic and life-altering, the need to provide assistance to these families and individuals should not be overlooked. A House version failed to pass during the summer, but with renewed support from the White House, a revised bill may be introduced this fall for passage.

Since September, 2001, Americans have fought to keep their lives normal. But those who witnessed the events in New York, DC, and Pennsylvania will always be affected on a personal level for the rest of their lives. According to the National Institutes of Health, in addition to hazardous chemical and physical environmental exposures, the working conditions at the WTC involved exposures to serious psychosocial stressors, including long hours and arduous work, treacherous and chaotic working conditions, fear for personal safety, and handling body parts and personal effects of victims, or working in close proximity to such operations. Post Traumatic Stress Disorder (PTSD) prevalence has been comparable to that seen in returning Afghanistan war veterans and was much higher than in the U.S. general population. Comorbidity has been found to be extensive and included extremely high risks for impairment of social function. PTSD was significantly associated with loss of family members and friends, disruption of family, work, and social life, and higher rates of behavioral symptoms in children of workers; and psychological distress and psychopathology in WTC workers greatly exceed population norms.

As America observes the ninth anniversary of 9/11, the country has rebounded with a spirit that has kept the spiritual and emotional levels intact. Of course, the nation struggles daily with the war between good and evil. Religious tolerance is still an ongoing battle as the division between Christianity and Islam continues to widen, even though many are working toward resolution of ideological differences. The eternal conflict between the forces of darkness and the forces of light is not going away. The US armed forces are still in a protracted effort to maintain peace in areas of the world that hate America and all for which it stands--freedom, love of country, national pride, capitalism, and family values. Although the long term effects have yet to be determined, enough time has elapsed to show that the physical health of those most closely associated has been profoundly affected. Also, the mental stress has had lingering effects on everyone who experienced the events first hand on that day. The nation is dealing with the ongoing nature of an event that changed the way people function--travel, security, healthcare, finance, and more.

As long as there are Americans, the nation will remember what happened on September 11, 2001. We will never forget!

Until next time. Let me know what you think.

Health Care and Labor Day

Labor Day--the last major holiday weekend of the summer season is fast approaching, and in a few days millions of Americans will be hitting the road for a vacation destination that will be short lived but well deserved. Before the hectic final quarter of the year sets in and Thanksgiving and the Christmas Season comes around, the time to relax for a brief but enjoyable time with family and friends is what the majority of people in the US look forward to as the last breath of the Summer. Children in many parts of the country start back to school after this weekend, and the end of the year after Labor Day is typically the final hard charging days of business for most companies for 2010.

According to the US Department of Labor (DOL), Labor Day, the first Monday in September, is a creation of the labor movement and is dedicated to the social and economic achievements of American workers. It constitutes a yearly national tribute to the contributions workers have made to the strength, prosperity, and well-being of our country. In the early years of this celebration going back to the 1880's, the form that the observance and celebration of Labor Day were outlined in the first proposal of the holiday — a street parade to exhibit to the public "the strength and esprit de corps of the trade and labor organizations" of the community, followed by a festival for the recreation and amusement of the workers and their families. This became the pattern for the celebrations of Labor Day.

The character of the Labor Day celebration has undergone a change in recent years, especially in large industrial centers where mass displays and huge parades have proved a problem. This change, however, is more a shift in emphasis and medium of expression, according to the. Now, according to the DOL, speeches by leading union officials, industrialists, educators, clerics and government officials are given wide coverage in newspapers, radio, and television in observance of the holiday. The vital force of labor added materially to the highest standard of living and the greatest production the world has ever known and has brought us closer to the realization of our traditional ideals of economic and political democracy. It is appropriate, therefore, that the nation pay tribute on Labor Day to the creator of so much of the nation's strength, freedom, and leadership — the American worker.

Labor Day is a weekend of fun, excitement, and enjoying the last days of summer. The last thing anyone wants to do is end up spending their time in the emergency room, but hundreds of people each year find themselves in that exact place wondering how injury or even death could have been prevented. Here are a few easy and useful tips on how to keep your Labor Day injury and accident free, according to AssociatedContent.com:

First, Labor Day is often a day of busy traffic and congested roads and the number one cause of injury and death during the holiday is vehicle related. To ensure you get wherever you are going in one peace, do a quick check on your car before traveling over the holiday weekend. First, make sure your coolant levels are sufficient to combat the last of that summer heat, then do a check on other essential fluids like oil and power steering. After that, check your tires to make sure that they are filled properly and aren't wearing thin anywhere. A blowout or flat tire is the last thing anyone needs while trying to enjoy themselves. A few minutes before heading out to check the fluid and tires will save you having to try and find an open mechanic on a holiday weekend. The next thing to consider regarding driving is something that may seem obvious, but make sure that you or the person driving is not tired or intoxicated. Having a delayed response time is not a good idea at any point while driving, but is particularly hazardous on a weekend where there are higher numbers of drivers on the road.

Secondly, in regards to personal safety during events, be smart and don't take unnecessary risks. This doesn't mean that you can't go out and water ski or bungee jump, but make sure you are taking a calculated risk and are using appropriate safety gear for whatever sport or activity you choose to involve yourself in. Stay hydrated, don't forget to eat, and if you're drinking, don't drive or operate machinery of any kind. Driving a boat drunk is still drunk driving! Also, remember that drinking impairs judgment and causes you to dehydrate so make sure you're drinking water during or after your time drinking. Beyond ensuring that you don't cause serious dehydration, it will help you avoid that hangover the next morning.

Third, another thing to consider is bugs and wildlife in the great outdoors. For most the consideration will only be mosquito and spider bites, but educate yourself on the area you will be staying to make sure there aren't other critters you need to consider. Snakes, poisonous spiders, and even coyotes and bears may be something you need to be aware of if you're out camping or hiking. Having a well-stocked first aid kit with you is essential to treating any injuries or bites that may occur while you are out.

Fourth, don't assume that any place is child-proof or that they notice faults or hazardous conditions regarding their equipment or tools. Be careful when renting tools that upon inspection they do not have hazardous wiring conditions, loose parts, and various other problems. Look at safety gear issued with sponsored rafting events and kayaking trips that do not have defects that could prove deadly if you do not take the time to inspect it before being given to you by the rental company. Don't assume that safety gear is automatically in good shape. Take the few extra minutes to make sure all fasteners, buckles, and other devices are in good working order before trusting your life to them.

Finally, the most important factor in preventing injury is educating yourself. Look up safety on the things you will be doing from grilling to getting in some last minute building projects over the holiday weekend. Look up things like the 101 Critical days of summer which is a military initiative for summer safety to minimize troop injury and death during the summer. Ultimately safety is everyone's responsibility, take a few precautions for yourself and your friends and make the weekend something to remember for years to come with the fun you have, not the injuries you sustain.

And remember the addage about drinking and driving---they don't mix. According to OHSOnline.com, the U.S. Department of Transportation Wednesday kicked off the annual “Drunk Driving. Over the Limit. Under Arrest.” campaign aimed at getting drunk drivers off the road. The National Highway Traffic Safety Administration (NHTSA) also released new data indicating that eight percent of all drivers, as many as 17 million people, have driven drunk at least once during the past year. The law enforcement crackdown will run through Labor Day and will involve thousands of police agencies from across the nation. Drunk driving is deadly, it’s against the law, and unfortunately, it’s still a problem. Their message is loud and clear. If you drive drunk you will be arrested and prosecuted. There will be no exceptions and no excuses. And if you’re below the age of 21, there is zero tolerance for any alcohol in your system whatsoever.

Have fun this Labor Day weekend. Enjoy the time off, and relax until the rat race heats up again after Monday. But remember to heed the suggestions about safety and your health so you can savor the memories of good times, not bad experiences due to lack of common sense and proper planning.

Until next time. Let me know what you think.

Health Care and Sunburn

When you are out in the sun, especially during the warmer months of the year, the best advice anyone can give you is to protect yourself from sunburn. The ultraviolet rays (UVA and UVB) can be deadly if you don't use protection with clothing and sunscreen that has a high SPF rating. If you've ever had a sunburn, you know it hurts. Severe burns need medical attention and can lead to more critical health care issues both short term and long term.

According to eMedicineHealth.com, sunburn results from too much sun or sun-equivalent exposure. Almost everyone has been sunburned or will become sunburned at some time. Anyone who visits a beach, goes fishing, works in the yard, or simply is out in the sun can get sunburn. Improper tanning bed use is also a source of sunburn. Yet although seldom fatal (sun poisoning), sunburn can be disabling and cause quite a bit of discomfort. Sunburn is literally a burn on your skin. It is a burn from ultraviolet (UV) radiation. The consequence of this burn is inflammation of the skin. Injury can start within 30 minutes of exposure.

UVA and UVB refer to different wavelengths in the light spectrum, according to eMedicineHealth.com. UVB is more damaging to the skin especially for skin cancer. Both UVA and UVB are responsible for photoaging (premature aging of the skin and wrinkles) and sunburn. Tanning beds produce both UVA and UVB rays. Travel to the southern United States, regions close to the equator, and places at high altitudes all offer the unwary visitor an opportunity to be injured by sunburn. Certain light-skinned and fair-haired people are at greater risk of sunburn injury. Prior recent sun exposure and prior skin injury are risks for sunburn, even in limited exposure to the sun. However, normal limited exposure to UV radiation produces beneficial vitamin D in the skin.

You know sunburn when it happens: red, painful skin that feels hot to the touch. Sunburn usually appears within a few hours after sun exposure and may take from several days to several weeks to fade, according to the Mayo Clinic. Intense sun exposure that results in sunburn increases your risk of certain complications and related skin diseases. These include dry, wrinkled skin; liver spots; actinic keratoses; and skin cancer, including melanoma. You can prevent sunburn and the related skin conditions by protecting your skin whenever you're outdoors, even on cloudy days. If you do get sunburn, several home remedies and treatments can relieve your pain and speed the healing of your skin.

Surveys of US adults show that men have a slightly higher prevalence of sunburn than women, according to Medscape.com. Sunburn is more common in children than in adults. Patients at highest risk typically have fair skin, blue eyes, and red or blond hair. The acute inflammatory response is greatest 12-24 hours after exposure. Other symptoms include the following:
--Erythema.
--Warmth.
--Tenderness.
--Edema.
--Blistering (severe cases), a sign of either a superficial partial-thickness or deep partial-thickness (second-degree) burn.
--Fever can present in severe cases.
--UVR may be transmitted through clothing, especially when wet, so sunburn may occur under clothed skin.
--Delayed scaling and desquamation occurs 4-7 days after exposure.

Home treatment measures may provide some relief from a mild sunburn, according to WebMD.com. Some examples include the following:
--Use cool cloths on sunburned areas.
--Take frequent cool showers or baths.
--Apply soothing lotions that contain aloe vera to sunburned areas. Topical steroids (such as 1% hydrocortisone cream) may also help with sunburn pain and swelling. Note: Do not use the cream on children younger than age 2 unless your doctor tells you to. Do not use in the rectal or vaginal area in children younger than age 12 unless your doctor tells you to.
--A sunburn can cause a mild fever and a headache. Lie down in a cool, quiet room to relieve the headache. A headache may be caused by dehydration, so drinking fluids may help.
There is little you can do to stop skin from peeling after a sunburn-it is part of the healing process. Lotion may help relieve the itching. Other home treatment measures, such as chamomile, may help relieve your sunburn symptoms. Additionally, using pure Aloe Vera on sunburn can act as a healing and cooling agent.

According to the Mayo Clinic, you should consult a doctor for sunburn treatment if:
--Severe sunburn covers a large portion of your body with blisters.
--Sunburn is accompanied by a high fever or severe pain.
--Severe sunburn doesn't begin to improve within a few days. To prevent future episodes of sunburn, use sunscreen frequently and liberally. Select a broad-spectrum product — one that provides protection against both ultraviolet A (UVA) and ultraviolet B (UVB) radiation — with a sun protection factor (SPF) of at least 15. If you take medications that make sunburn more likely, be especially careful. A common example is tetracycline taken orally for acne. Common sense counts, too. Cover up while you're outdoors, and stay in the shade as much as possible.

According to the National Institutes of Health, call a health care provider immediately if you have a fever with sunburn or if there are signs of shock, heat exhaustion, dehydration, or other serious reaction. These signs include:
--Feeling faint or dizzy.
--Rapid pulse or rapid breathing,
--Extreme thirst, no urine output, or sunken eyes.
--Pale, clammy, or cool skin.
--Nausea, fever, chills, or rash.
--Your eyes hurt and are sensitive to light.
--Severe, painful blisters.

To prevent sunburn and other skin conditions, according to the Mayo Clinic, use all three of these sun protection methods:
1.) Avoid the sun between 10 a.m. and 4 p.m. Because the sun's rays are strongest during these hours, try to schedule outdoor activities for other times of the day. Seek shade whenever possible. If you're unable to avoid being in the sun, limit the amount of time you're outdoors during these peak hours.
2.) Cover up. Wear tightly woven clothing that covers your arms and legs and a broad-brimmed hat, which provides more protection than does a baseball cap or golf visor. Also, consider wearing clothing or outdoor gear specially designed to provide sun protection.
3.) Use sunscreen frequently and liberally. Apply sunscreen liberally 30 minutes before going outdoors and reapply about every two hours — sooner if it's washed away by perspiration or water.

While the sun is out, it's important to highlight the risk of spending long periods of time in the sun without protection at home as well as abroad, according to DailyMail.co.uk. It only takes one serious burn to potentially have lasting consequences when it comes to your skin. What people need to realize is that people with fair skin can burn in a matter of minutes in the strong summer sun, so it's always better to be prepared and slap on some sunscreen before heading out. Also, specialists warn that anyone who has suffered from sunburn should stay out of the sun when it is at its strongest, because previous damage can make the skin more sensitive and raise the risk of cancer.

Being tan can be cool, but being burnt is not. Be careful when you are outside that you protect yourself from the sun's damaging rays. Who wants to suffer from a bad day at the lake because your sunscreen washed off and you didn't cover up? Do you work outside for a living? Then make sure you follow the same safety rules to protect that skin. Keep kids covered up, and make sure any seniors outside are protected from the sun as well. Skin cancer is no day at the beach.

Until next time. Let me know what you think.

Health Care and Hot Cars

During the summer and other especially warm days during the year, the weather, humidity, and sun light can heat up the inside of your car to an amazingly hot temperature. Unfortunately, every year the news stations tell tragic stories of children and pets who are left inside a locked vehicle for several hours during the heat of the day, and the results are most often deadly. According to ABCNews.com, the temperature in a closed car can rise 19 degrees in 10 minutes and 43 degrees in an hour, so even cooler days present risks. From 1998 through 2009, 51 percent of the deaths involved children forgotten in cars, 30 percent were children playing in unattended vehicles, and 18 percent were intentionally left in cars.

According to GGWeather.com, here are some scary statistics:
--Heatstroke occurs when a person's temperature exceeds 104 degrees F and their thermoregulatory mechanism is overwhelmed - Symptoms include : dizziness, disorientation, agitation, confusion, sluggishness, seizure, hot dry skin that is flushed but not sweaty, loss of consciousness, rapid heart beat, hallucinations.
--A core body temperature of 107 degrees F is considered lethal as cells are damaged and internal organs shut down.
--Children's thermoregulatory systems are not as efficient as an adult's and their body temperatures warm at a rate 3 to 5 times faster than an adult’s.

The atmosphere and the windows of a car are relatively “transparent” to the sun’s shortwave radiation and are warmed little. However, according to GGWeather.com, this shortwave energy does heat objects that it strikes. For example, a dark dashboard or seat can easily reach temperatures in the range of 180 to over 200 degrees F. These objects (e.g., dashboard, steering wheel, childseat) heat the adjacent air by conduction and convection and also give off longwave radiation which is very efficient at warming the air trapped inside a vehicle. “Cracking” the windows have little effect. Vehicle interior color is probably the biggest factor. Parents and other caregivers need to be educated that a vehicle is not a babysitter or play area ... but it can easily become tragedy.

It wouldn't seem like you would need to warn people about leaving kids alone in a car, especially during the heat of the summer, but it seems like every week there are new reports of kids dying after being left in a hot car, according to KeepKidsHealthy.com. Why are kids left in hot cars?

Often it is an 'accident', either by a parent or other caregiver. One report in Dallas involved a toddler who died after being left in a van after daycare workers forgot him there after a field trip. Another case, fortunately with the kids being found before they were injured, involved a mother who left her two kids in a closed car while she went grocery shopping. Other cases have involved parents who forget to drop their kids off at daycare and leave them in a hot car while they go to work. And already this year, there are reports of kids being left in hot cars in Utah and California, in addition to the cases in Texas.

So don't leave your kids alone in a car. It sounds simple, but it happens all too often. Even if you are just running into a store or to see a friend for a few minutes, don't leave your kids in the car, according to KeepKidsHealthy.com. When you get home from shopping or from a trip, get your kids in the house and then worry about unpacking the car. If you leave your kids in the car while you go inside first, it is easy to get distracted and forget they are still in the car. Maybe the phone rings, or the dishwasher is overflowing, or something else happens to distract you. If your kids are in daycare and they take younger kids on field trips or pick the child up from your home, make sure that they have a good plan to make sure kids aren't left in the car or van. Do they count the kids? Does somebody check the vehicle after everyone is unloaded?

Some parents may not want to take their child in and out of their cumbersome car seat for what they believe will be a quick stop at the dry cleaner, others may actually forget that their sleeping child is in the back seat, and sometimes children lock themselves in a car by accident, according to WebMD.com. Preventing hot car casualties starts with these steps:

1.) No Exceptions, No Matter How Brief--It is never OK to leave kids or pets in a car -- even with the windows down. Your car is a greenhouse and temperatures can get exceedingly hot in an exceedingly short period of time. We are talking minutes. Kids are more susceptible and at higher risk for heat-related illness and injury than adults because their bodies make more heat relative to their size and their abilities to cool through sweating are not as developed as adults.

2.) Know What Can Go Wrong--Parents leave children in a car for lack of understanding about how sick they can get and how quickly they can get sick. On a day that is just 72 degrees Fahrenheit, the temperature can increase by 30 to 40 degrees in an hour, and 70% of this increase occurs the first 30 minutes. As previously stated, heat stroke may occur when body temperature passes 104 degrees Fahrenheit.

3.) Get Involved--If you see something, say something.

4.) Remind Yourself--Some parents or caregivers may forget that there is a sleeping child in the back seat and go about their business. The memory is faced with a challenge when it needs to remember something that you don’t do every day, such as take your child to school. For instance, maybe Mom usually does that, but for some reason, Dad takes the task for the day. If the child has fallen asleep in their car seat, which is usually behind the driver’s seat, there is no visual information to remind you that there is a kid to drop off; and if you have not done it day in and day out, you need a cue. These are not bad parents, but people who don’t have a good understanding of their memory system. What can you do? Give yourself reminders. Keep telling yourself, out loud, to remember the child. And give yourself visual cues. For example, place your briefcase beside your child so you must grab it before going to work, and will see your child. Or put your diaper bag on the seat next to you, so that you're reminded that you have the child with you.

5.) Prevent Kids From Wandering Into the Car--Don't let your children play in your car, make sure the car's doors and trunk are locked when you're not using it, and keep the keys out of kids' reach. That may help prevent children from getting accidentally locked in the car.

6.) Check That They Arrived--If your children take school buses or other modes of transportation, make sure that the transportation company follows established safety protocols, such as a bus driver walking through the bus to make sure no child is left onboard at the end of the route. And call to make sure your child arrives as expected, if you are not there to greet your child.

In addition to kids being left in cars, they can also get trapped in a hot car if they get into the car by themselves, according to KeepKidsHealthy.com. Locking your car, especially the trunk, and securing your car keys out of your child's reach can help to prevent these injuries. Many children climb into unlocked vehicles without their parents’ or guardians’ knowledge, according to NHTSA.gov. Once in the car, they may become confused by the door handle’s configuration and be unable to open the door from the inside. Also, children may accidentally lock doors by leaning on a power control device and be unable to get out. In warm weather, a vehicle can warm to dangerous, life-threatening levels in only 10 minutes.

What happens to people who leave a child alone in a car on a warm day? Well, according to KeepKidsHealthy.com, in addition to possibly losing their child, they are likely to face charges over the incident. What if you see a child alone in a hot car? Call 911 and seek immediate medical attention. Don't waste time looking for the parent.

Remember, children are your most precious cargo, and they deserve your utmost attention all the time. They look to parents and caregivers to keep them safe. A hot car is not. The memory of a child lost due to death in a hot vehicle will haunt you forever. Be safe, not sorry.

Until next time. Let me know what you think.

Health Care and Health Exchanges

Now that Obamacare has been in place for a few months, and HHS Secretary Kathleen Sebelius has been in charge as the lead person for orchestrating the rollout of the massive new legislation, Americans are learning more and more every day about how the new law will affect consumers, businesses, and the nation at large. According to InsuranceNewsNet.com, the National Association of Insurance Commissioners (NAIC) informed Secretary Sebelius that only half of the states have explicit legal authority to enforce the health reform law, but the remaining states can rely on other means to hold insurers accountable for their compliance with federal laws.


Those powers -- which include form approval, investigative powers and market conduct exam authority -- along with a coordinated effort by the federal regulators, should be sufficient to ensure carriers comply with the new requirements under the health reform law. The NAIC, according to InsuranceNewsNet.com, says it surveyed the states and found that that more than half concluded that they can enforce the law either through explicit state law or via general powers granted to the commissioners. The insurance commissioners say they agree with Sebelius' assertion that enforcing the new health reform mandates will require cooperation and coordination. The experience implementing the Health Insurance Portability and Accountability Act (HIPAA), the Mental Health Parity and Addiction Equity Act and other federal insurance laws shows that a strong partnership is effective and in the best interest of consumers.


Specialty health plans, which offer services ranging from behavioral health and chiropractic to hearing and vision, worry that the health reform law may not allow people to shop for most specialty services through health insurance exchanges. According to AISHealth.com, such exchanges will begin in 2014 for individuals and small groups. One main concerns is, with the exception of dental, no other specialty health organizations were listed in the reform bill to be a part of the exchanges. Vision was in there, but it was taken out as one of the last amendments. Specialty health plans furnish specialty services to more than 175 million Americans. Dental is different because it is listed in the law as being a product that can be sold within the exchange. So, you are allowed to purchase a stand-alone dental plan as part of the exchange. But if you want to do that with vision care, you do not have that option. However, as states set up exchanges, states may decide to add various types of coverage, including specialty insurance products. There is also some anticipation of federal legislation in 2011 clarifying what may comprise exchange offerings.


Yet at this point, according to AISHealth.com, it seems the states are going to have more leeway than they thought with respect to how exchanges are set up. That could mean significant variation among states with respect to specialty health plans’ role in exchanges, but much will hinge on definitions and ongoing discussions between HHS and the National Association of Insurance Commissioners on how to handle exchanges. And according to USA Today, the main part of the health overhaul law takes effect in 2014, when there's a major expansion of insurance coverage and the creation of new state-based health insurance exchanges, which are marketplaces to make it easier for individuals and small businesses to buy insurance. These exchanges will have their own websites.

According to the Commonwealth Fund, health insurance exchanges are the centerpiece of the private health insurance reforms of the Affordable Care Act of 2010 (ACA). If they function as planned, these exchanges will expand health insurance coverage, improve the quality of such coverage and perhaps of health care itself, and reduce costs. Previous attempts at creating health insurance exchanges, however, enjoyed only mixed results. As part of successfully implementing the new exchanges, the U.S. Department of Health and Human Services (HHS) and the states must address issues that undermined the earlier attempts. These issues are:


--Adverse selection. It is absolutely necessary that exchanges be protected against adverse selection (the disproportionate purchase of health insurance by the least healthy individuals)—especially because, under the ACA, small-group and nongroup insurance options remain available outside the exchanges. However, a number of provisions of the ACA level the playing field inside and outside the exchange, and weaken incentives for adverse selection. These protections can also be enhanced by the states.
--Numbers of participants. Exchanges that include large numbers of enrollees, as well as a high percentage of the total number of enrollees who are participating in the entire insurance market, offer greater market power, economies of scale, more stable risk pools, and stronger protection against adverse selection. The ACA offers opportunities for expanding risk pools, which should be fully exploited.
--Market coverage and structure. The ACA permits both the combination and separation of small-group and nongroup risk pools and exchanges. It also allows the creation of regional or subsidiary exchanges. The advantages and disadvantages of pursuing these options must be carefully weighed.
--Choice without complexity. The exchange model created by the ACA presents consumers with structured choices. An important implementation decision will be whether to further structure choices or, alternatively, to offer maximum choice and flexibility within the constraints of the ACA.
--Transparency and disclosure. The ACA contains numerous provisions designed to maximize transparency and disclosure. Putting these requirements into operation will be one of the Act’s most important implementation tasks.
--Competition. The exchanges are intended to increase competition among insurers and focus that competition on value and price. A number of provisions of the ACA should help to facilitate this objective.
--Administrative costs. The ACA requires exchanges to fulfill a number of administrative functions that will add to their costs. Exchanges must find ways to reduce such internal costs, as well as the administrative costs to insurers and employers, if they are to offer better value to enrollees.
--Market or regulator? The ACA delegates to exchanges a number of regulatory responsibilities. Exchanges must certify health plans for participation and can exercise regulatory authority through this power. An important implementation choice will be whether exchanges should, on the one hand, maximize plan participation by minimizing certification requirements or, on the other hand, use their certification authority to limit exchange participation to high-value plans.
--Administering subsidies and mandates. The exchanges will play important roles in establishing insurance affordability, administering cost-sharing subsidies, and serving as a gateway to other public programs. It is particularly important that exchanges coordinate seamlessly with other public programs because participants will often move back and forth between an exchange, Medicaid, and the Children's Health Insurance Program (CHIP).
--State, regional, or national exchanges? Although the ACA favors the creation of state exchanges, it also confers authority to create a federal exchange as well as a multistate insurance program, and it provides for the possibility of regional exchanges. Important policy choices will need to be made concerning which avenues particular states should pursue and how the federal government should react to state action—or inaction.
--Governance. The ACA provides very little guidance as to how exchanges should be governed. HHS and the states must carefully consider how the entities that govern exchanges should be structured and how they relate to other state and to federal institutions.
--Relationships with employers. Although exchanges must be employer-friendly if they are to succeed, the ACA offers little guidance in this regard. Such relationships nevertheless need to be a major focus of implementation efforts.
--Cost control. Exchanges have been sold as a mechanism for moderating the growth of health insurance costs. Achieving this objective will only be possible if exchanges are implemented so as to maximize competition, choice, and participation and to minimize administrative cost and adverse selection.

According to BenefitNews.com, regulators hope that the exchanges will to be Web-based, one-stop shops for consumers to compare and purchase health insurance coverage. HHS' Office of Consumer Information and Insurance Oversight is seeking views on a number of issues related to insurance exchanges, including factors that states will consider when determining whether to build an insurance exchange or use an alternate federal solution; implementation timeframes; and aspects of exchanges that should be uniform across the states. For employers that plan to interact with state-level health exchanges under PPACA, federal regulators want to know the following:
--What exchange design features are likely to be most important for employer participation, including the participation of large employers in the future? What are some relevant best practices?
--What factors are important for consideration in determining the employer size limit (e.g., 50 versus 100) for participation in a given state’s exchange?
--What considerations are important in facilitating coordination between employers and exchanges? What key issues will require collaboration?
--What other issues are there of interest to employers with respect to their participation in exchanges?

According to AIS Health, the statute language regarding specialty care recognizes the importance of stand-alone dental providers by allowing individuals and small groups seeking coverage through exchanges to purchase their children’s dental benefits separately from dental carriers experienced in dental benefit plan design and administration. Insurance and discount plans could qualify for this option. The vast majority of Americans with dental coverage obtain it apart from their medical insurance and through stand-alone dental providers, and they can still do so under exchanges. But when people begin making coverage decisions through exchanges, and dental is bundled within some medical plans, it would be helpful to know how much of the bundled cost applies to dental coverage in order to make apples-to-apples comparisons with separate dental products. A section on nondiscrimination in health care states that no plan or insurer may discriminate against any provider acting within the scope of that provider’s license or certification under state law.

According to HealthCareTownHall.com, the state healthcare exchanges that will be created as part of the Patient Protection and Affordable Care Act are intended to bring buyers and sellers together in a single marketplace for qualified health insurance. While the idea of a single marketplace is relatively straightforward, there are numerous underlying complexities, including plan cost, affordability, access, group size, participant age, marketing and education, eligibility, plan qualification, and risk adjustment. States that plan to establish exchanges should be well aware of these issues and should determine the best course of action depending on their specific circumstances.

The jury is still out, and in three years the landscape for health care in America will be drastically different than it is today. Insurance companies, states, regulators, employers, and all consumers will need to study hard to get ready. No more business as usual. Granted there will be more twists and turns along the way until the exchanges are in place. And there is still a huge amount of regulatory issues that are not yet resolved. Those stakeholders who do not get up to speed before the transition will be lost in the shuffle. Then it might be too late if you are behind the eight ball. Best advice....save as much money as you can til then because the price to be insured is gonna get expensive.

Until next time. Let me know what you think.

Health Care and Summer Heat

"Summer time, and the livin' is easy. Fish are jumpin, and the cotton is high." So go the lyrics of a famous George Gershwin tune--"Summer Time." What a great time of year, school is out and kids run free. Parties and picnics, swimming pools and the beach, and countless hours doing yard work and a myriad of other fun things that keep you outside in the sun. Yes, summer time is the season that everyone looks forward to for vacations, beautiful gardens and lawns, and super fun--except for the heat. Americans love the sun, but the heat during this time of year can be a killer.

According to the Centers for Disease Control and Prevention (CDC), the best defense against extreme heat is prevention. Here are some prevention tips:
--Drink more fluids (nonalcoholic), regardless of your activity level. Don’t wait until you’re thirsty to drink. Warning: If your doctor generally limits the amount of fluid you drink or has you on water pills, ask him how much you should drink while the weather is hot.
--Don’t drink liquids that contain alcohol or large amounts of sugar–these actually cause you to lose more body fluid. Also, avoid very cold drinks, because they can cause stomach cramps.
--Stay indoors and, if at all possible, stay in an air-conditioned place. If your home does not have air conditioning, go to the shopping mall or public library–even a few hours spent in air conditioning can help your body stay cooler when you go back into the heat. Call your local health department to see if there are any heat-relief shelters in your area.
--Electric fans may provide comfort, but when the temperature is in the high 90s, fans will not prevent heat-related illness. Taking a cool shower or bath, or moving to an air-conditioned place is a much better way to cool off.
--Wear lightweight, light-colored, loose-fitting clothing.
--NEVER leave anyone in a closed, parked vehicle.

Although any one at any time can suffer from heat-related illness, some people are at greater risk than others, according to the CDC. Check regularly on:
--Infants and young children.
--People aged 65 or older.
--People who have a mental illness.
--Those who are physically ill, especially with heart disease or high blood pressure.
--Visit adults at risk at least twice a day and closely watch them for signs of heat exhaustion or heat stroke. Infants and young children, of course, need much more frequent watching.

According to RedCross.org, the summertime extreme heat can cause actual physical difficulties which in some instances can be life-threatening. Heat cramps are muscular pains and spasms in the legs or abdomen caused by exposure to high heat and humidity and loss of fluids and electrolytes. Heat cramps are often an early sign that the body is having trouble with the heat, and in order to help someone with heat cramps you can follow these suggestions:
--Get them to a cooler place and have them rest in a comfortable position. Lightly stretch the affected muscle and replenish fluids.
--Give a half glass of cool water every 15 minutes. Do not give liquids with alcohol or caffeine in them, as they can make conditions worse.

Heat exhaustion involves the loss of body fluids through heavy sweating during strenuous exercise or physical labor in high heat and humidity, according to RedCross.org. Signs include cool, moist, pale or flushed skin, heavy sweating, headache, nausea, dizziness, weakness and exhaustion. If someone is suffering from heat exhaustion, you should:
--Move them to a cooler place. Remove or loosen tight clothing and apply cool, wet cloths or towels to the skin. Fan the person. If they are conscious, give small amounts of cool water to drink. Make sure the person drinks slowly. Watch for changes in condition.
--If the person refuses water, vomits or begins to lose consciousness, call 9-1-1 or the local emergency number.
--Heat stroke is a life-threatening condition in which a person’s temperature control system stops working and the body is unable to cool itself. Signs of heat stroke include hot, red skin which may be dry or moist; changes in consciousness; vomiting; and high body temperature.
Heat stroke is life-threatening. Call 9-1-1 or the local emergency number immediately.
--Move the person to a cooler place. Quickly cool the person’s body by giving care as you would for heat exhaustion. If needed, continue rapid cooling by applying ice or cold packs wrapped in a cloth to the wrists, ankles, groin, neck and armpits.

High heat and humidity can do a number on diabetics, affecting perspiration, medication and supplies, according to the Los Angeles Times. But not everyone who has diabetes is aware of how weather might affect them. People with diabetes have an impaired ability to sweat, which predisposes them to heat-related illness, as do uncontrolled, high blood sugars. Heat illness can take place at 80 to 90 degrees when you factor in the heat index, which is the air temperature plus the relative humidity. The two combined is how you perceive how hot it is. Also, the higher the humidity, the less perspiration evaporates. Some diabetes medication (such as insulin) and supplies may also be affected by high heat, but many diabetics are not sure how to deal with the heat and their supplies. Diabetes medication and glucose testing tools such as meters and test strips should be kept from heat.

According to NetWellness.org, summer heat and sun may potentially put some medication users and alcohol and/or drug abusers at increased risk. Do not stop taking any prescribed medication without first talking to your doctor. The body needs to maintain a relatively consistent temperature to function properly. Some medicines can block the natural ability of the body to adjust to changes in temperature. This can result in overheating. As the outside temperature increases, the body keeps from overheating by releasing excess heat. The most important ways the body releases heat are by:
--Increasing blood flow to the skin.
--Sweating.
These two actions work together--increasing blood flow to the skin brings heat to the surface of the body where the skin acts like a large radiator. Sweating increases heat loss from the skin through the process of evaporation. Some medicines and drugs can disrupt these processes resulting in a reduced ability to adjust to temperature changes. To increase blood flow to the skin, the blood vessels in the body first inform the brain of the elevated temperature. The brain then sends a message to blood vessels to dilate, increasing blood flow to the skin. The heart must also work harder to circulate the blood. More info about drug interactions with extreme heat can be found at this site: http://www.netwellness.org/healthtopics/pharmacy/w18.cfm.

Summertime heat is an annoyance to some people, according to NaturalNews.com. However, sweating from the hot, summer heat is a natural part of keeping your body healthy, and avoiding this heat can actually cause health problems. People typically run their air conditioners throughout the summertime in order to beat the heat, but doing so can actually compromise the immune system. Summer is the time to sweat. It's a natural process for the body to respond to the outside environment, and adjust itself through the constricting of blood vessels and nerves. Excessive sweating without replenishing the body with water, electrolytes and healthy salt, can be a bad thing, but not sweating at all can be even worse. And moving from hot areas to cold areas, and vice versa, on a regular basis throughout the summer can put excessive strain on a person's health. Sweating is also an important method by which the skin helps to eliminate toxins from the body. One of the skin's functions is to eliminate a portion of the body's toxic waste products through sweating.

Just be careful, though, when the temperature goes up, and especially if the heat goes into the triple digits. Although sweating can relieve some toxins in your body, the overall consensus by medical providers is to not get overheated. That can be very dangerous, especially if you are in a high risk group like diabetics, the elderly, or have other health issues. Always consult your doctor if you feel that you are having problems dealing with the heat, and make sure that 911 is on your phone speed dial if you experience major medical problems when the temperature goes way up. Staying cool during the summer is a good idea, but if you have to be outside when it's hot, take preventive measures to ensure you survive.

Until next time. Let me know what you think.