From Health and Fitness

Watch: ACA’s Future And ‘Medicare-For-All’ Front And Center As Candidates Line Up For 2020

Julie Rovner, KHN’s chief Washington correspondent, joined C-SPAN host Bill Scanlan Tuesday morning on “Washington Journal” to discuss how health care is playing out in the current political debate. They talked about the Republican-sponsored lawsuit to overturn the Affordable Care Act and the backing by many Democratic candidates of a “Medicare-for-all” health plan, and took questions from viewers about a wide variety of health issues. The video is available on the C-SPAN website.

Rovner also was on NPR’s “Weekend Edition Saturday” with host Scott Simon to talk about Sen. Bernie Sander’s “Medicare-for-all” proposal. That is available on the NPR website.

Watch: ACA’s Future And ‘Medicare-For-All’ Front And Center As Candidates Line Up For 2020

Julie Rovner, KHN’s chief Washington correspondent, joined C-SPAN host Bill Scanlan Tuesday morning on “Washington Journal” to discuss how health care is playing out in the current political debate. They talked about the Republican-sponsored lawsuit to overturn the Affordable Care Act and the backing by many Democratic candidates of a “Medicare-for-all” health plan, and took questions from viewers about a wide variety of health issues. The video is available on the C-SPAN website.

Rovner also was on NPR’s “Weekend Edition Saturday” with host Scott Simon to talk about Sen. Bernie Sander’s “Medicare-for-all” proposal. That is available on the NPR website.

Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs — efforts to get workers to lose weight, eat better, stress less and sleep more — are an $8 billion industry in the U.S.

Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act.

But no one has been sure they work.

A host of studies over the years has provided conflicting results, with some showing savings and health improvements while others say the efforts fall short.

Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.

Researchers from the University of Chicago and Harvard may have overcome some of these obstacles with one of the first large-scale studies that employs more sophisticated research techniques. It was published Tuesday in JAMA.

They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.

“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t’ first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol — or making concerted efforts to participate in programs that might help them do so over time.

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

Wellness program vendors said details matter when considering whether efforts will be successful.

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.

An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

It could be, the study acknowledges, that 18 months isn’t enough time to track such savings. So, Baicker and Song also plan to publish three-year results once they are finalized.

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

In one interesting point, that study found that wellness-program participants were likely already healthier and more motivated, “thus a primary benefit of these programs to employers may be their potential to attract and retain healthy workers with low medical spending.”

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”

Workplace Wellness Programs Barely Move The Needle, Study Finds

Workplace wellness programs have become an $8 billion industry in the U.S. But a study published Tuesday in JAMA found they don’t cut costs for employers, reduce absenteeism or improve workers’ health.

Most large employers offer some type of wellness program — with growth fueled by incentives in the federal Affordable Care Act.

A host of studies over the years have provided conflicting results about how well they work, with some showing savings and health improvements while others say the efforts fall short.

Many studies, however, faced a number of limitations, such as failing to have a comparison group, or figuring out whether people who sign up for such wellness programs are somehow healthier or more motivated than those who do not.

Now researchers from the University of Chicago and Harvard may have overcome these obstacles with one of the first large-scale studies that is peer-reviewed and employs a more sophisticated trial design.

They randomly assigned 20 BJ’s Wholesale Club outlets to offer a wellness program to all employees, then compared results with 140 stores that did not.

The big-box retailer employed nearly 33,000 workers across all 160 clubs during the test.

After 18 months, it turned out that yes, workers participating in the wellness programs self-reported healthier behavior, such as exercising more or managing their weight better than those not enrolled.

But the efforts did not result in differences in health measures, such as improved blood sugar or glucose levels; how much employers spent on health care; or how often employees missed work, their job performance or how long they stuck around in their jobs.

“The optimistic interpretation is there is no way we can get improvements in health or more efficient spending if we don’t’ first have changes in health behavior,” said one study author, Katherine Baicker, dean of the Harris School of Public Policy at the University of Chicago. (Dr. Zirui Song, an assistant professor of health policy and medicine at Harvard Medical School, was its co-author.)

“But if employers are offering these programs in hopes that health spending and absenteeism will go down, this study should give them pause,” Baicker said.

The study comes amid widespread interest in wellness programs.

The Kaiser Family Foundation’s annual survey of employers found that 53% of small firms and 82% of large firms offer a program in at least one of these areas: smoking cessation, weight management and behavioral or lifestyle change. (Kaiser Health News is an editorially independent program of the foundation.)

Some programs are simple, offering gift cards or other small incentives to fill out a health risk assessment, take a lunch-and-learn class or join a gym or walking group. Others are far more invasive, asking employees to report on a variety of health-related questions and roll up their sleeves for blood tests.

A few employers tie financial incentives to workers actually lowering risk factors, such as high blood pressure or cholesterol — or making concerted efforts to participate in programs that might help them do so over time.

The Affordable Care Act allowed employers to offer financial incentives worth up to 30% of the cost of health insurance, leading some employers to offer what could be hundreds or even thousands of dollars off workers’ deductibles or premiums to get them to participate. That led to court challenges about whether those programs are truly voluntary.

In the study reported in JAMA, the incentives were modest. Participants got small-dollar gift cards for taking wellness courses on topics such as nutrition, exercise, disease management and stress control. Total potential incentives averaged $250. About 35% of eligible employees at the 20 participating sites completed at least one module.

Results from those workers — including attendance and tenure data, their self-reported health assessment and results from lab blood tests — were specifically compared with similar reports from 20 primary comparison sites where workers were not offered the wellness gift cards and classes. Overall employment and health spending data from all worksites were included in the study.

Wellness program vendors said details matter when considering whether efforts will be successful.

Jim Pshock, founder and CEO of Bravo Wellness, said the incentives offered to BJ’s workers might not have been large enough to spur the kinds of big changes needed to affect health outcomes.

Amounts of “of less than $400 generally incentivize things people were going to do anyway. It’s simply too small to get them to do things they weren’t already excited about,” he said.

An accompanying editorial in JAMA noted that “traditional, broad-based programs like the one analyzed by Song and Baicker may lack the necessary intensity, duration, and focus on particular employee segments to generate significant effects over a short time horizon.”

In other words, don’t give up entirely on wellness efforts, but consider “more targeted approaches” that focus on specific workers with higher risks or on “health behaviors [that] may yield larger health and economic benefits,” the editorial suggested.

It could be, the study acknowledges, that 18 months isn’t enough time to track such savings. So, Baicker and Song also plan to publish three-year results once they are finalized.

Still, similar findings were recently reported in another randomized control trial conducted at the University of Illinois, where individuals were randomly selected to be offered wellness programs.

In one interesting point, that study found that wellness-program participants were likely already healthier and more motivated, “thus a primary benefit of these programs to employers may be their potential to attract and retain healthy workers with low medical spending.”

Everyone involved in studying or conducting wellness agrees on one thing: Changing behavior — and getting people motivated to participate at all — can be difficult.

Steven Aldana, CEO of WellSteps, a wellness program vendor, said that for the efforts to be successful they must cut across many areas, from the food served in company cafeterias to including spouses or significant others to help people quit smoking, eat better or exercise more.

“Behavior is more complicated than simply taking a few wellness modules,” said Aldana. “It’s a lifestyle matrix or pattern you have to adopt.”

Tracking Devices, Special Apps Help Monitor Family Members With Dementia, But Technology Isn’t A Cure-All

Families are finding they’re able to keep loved ones with Alzheimer’s and other neurodegenerative diseases at home longer with special apps, but when those devices fail, as they’re apt to do at some point, life becomes tricky once again. News on Alzheimer’s looks at early warning signs and the burden on the African-American community, as well.

Tracking Devices, Special Apps Help Monitor Family Members With Dementia, But Technology Isn’t A Cure-All

Families are finding they are able to keep loved ones with Alzheimer’s and other neurodegenerative diseases at home longer with special apps, but if those devices fail then life becomes tricky once again. News on Alzheimer’s looks at early warning signs and the burden on the African-American community, as well.

Even People With Employer-Sponsored Plans Are Spending A Big Chunk Of Income On Health Insurance

“The affordability trends in the employer market are driven by healthcare costs rising a lot faster than the median income,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. The trends may be fueling some of the “Medicare for All” interest, experts say.

Even People With Employer-Sponsored Plans Are Spending A Big Chunk Of Income On Health Insurance

“The affordability trends in the employer market are driven by healthcare costs rising a lot faster than the median income,” said Sara Collins, vice president of healthcare coverage and access at the Commonwealth Fund. The trends may be fueling some of the “Medicare for All” interest, experts say.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

Changes To CMS Readmission Penalties Appear Effective In Addressing Unique Challenges Of Rural, Teaching Hospitals

The changes were made to address complaints from hospitals—safety-net hospitals in particular—that they are unfairly penalized in the readmissions program because of their complex patient case mix. For rural hospitals, their average penalties are estimated to decline from $55,268 to $53,633; while average penalties for teaching hospitals will drop from $287,268 to $283,461. Other news from CMS looks at accountable care organizations and primary care accounts.

‘Born-Alive’ Measure Passes North Carolina Senate, But Faces Possible Veto From Democratic Governor

The legislation would punish doctors who fail to treat babies who are born as part of a failed abortion attempt. Critics of the measure say that it’s attempting to fix a nonexistent problem, and that there are already penalties for doctors who do not treat babies who are born alive. Abortion news comes out of North Dakota, Alabama, Ohio and Kansas, as well.

‘Born-Alive’ Measure Passes North Carolina Senate, But Faces Possible Veto From Democratic Governor

The legislation would punish doctors who fail to treat babies who are born as part of a failed abortion attempt. Critics of the measure say that it’s attempting to fix a nonexistent problem, and that there are already penalties for doctors who do not treat babies who are born alive. Abortion news comes out of North Dakota, Alabama, Ohio and Kansas, as well.

Behind The Scenes, Three Key Figures Help Shape The Democrats’ Strategy On Reducing Drug Prices

Stat offers a closer look at Richard Frank, Lauren Aronson and Gerard Anderson — three of the key figures and Democratic health-policy thought leaders working closely with Wendell Primus, a top adviser for House Speaker Nancy Pelosi (D-Calif.). In other pharmaceutical news, the Supreme Court dealt pharma a loss by rebuffing Allergan’s efforts to shield patents by transferring them to a Native American tribe.

Behind The Scenes, Three Key Figures Are Helping Shape The Democrats’ Strategy On Reducing Drug Prices

Stat offers a closer look at Richard Frank, Lauren Aronson and Gerard Anderson–three of the key figures and Democratic health-policy thought leaders who have been working closely with Wendell Primus, a top adviser for House Speaker Nancy Pelosi (D-Calif.). In other pharmaceutical news, the Supreme Court dealt pharma a loss by rebuffing Allergan’s efforts to shield patents by transferring them to a Native American tribe.

In Midst Of Disaster Funding Stalemate, Rick Scott’s Campaign Promises To Stand Up For Puerto Rico Put Him In Tough Spot

Democrats are seizing the opportunity to blast Sen. Rick Scott (R-Fla.) for taking President Donald Trump’s side in the battle of disaster relief. But Scott is fighting back. “This is a great example of why people hate politics. Not only did @SenSchumer block a bipartisan bill, now he’s lying about it,” Scott tweeted Sunday evening. “Our bill doesn’t strip funding for P.R. It includes $600 mil in nutrition assistance funding for P.R. that I fought to get in the bill.” As the bickering in Washington continues, many in Puerto Rico are left uncertain and worried about the future.

In Midst Of Disaster Funding Stalemate, Rick Scott’s Campaign Promises To Stand Up For Puerto Rico Put Him In Tough Spot

Democrats are seizing the opportunity to blast Sen. Rick Scott (R-Fla.) for taking President Donald Trump’s side in the battle of disaster relief. But Scott is fighting back. “This is a great example of why people hate politics. Not only did @SenSchumer block a bipartisan bill, now he’s lying about it,” Scott tweeted Sunday evening. “Our bill doesn’t strip funding for P.R. It includes $600 mil in nutrition assistance funding for P.R. that I fought to get in the bill.” As the bickering in Washington continues, many in Puerto Rico are left uncertain and worried about the future.

Officials Report 90 New Cases Of Measles All But Guaranteeing 2019 Will Be Worst Year This Century Has Seen

While 20 states have reported cases, New York — in particular, ultra-Orthodox Jewish community that lives in Brooklyn — has been the epicenter of the outbreak. The infections test the boundaries between religious freedom and protection of public health. Meanwhile, the boom in cases in America is mirrored worldwide: globally there are four times as many measles cases so far this year as there were at the same time last year.

Town Hall Audience Erupts In Cheers When Asked About Support For Sanders’ ‘Medicare For All’ Plan

The slice of public opinion at the town hall for 2020 hopeful Sen. Bernie Sanders (I-Vt.) reflects broader polling that shows support for a system that guarantees universal coverage. However, when details about paying for the plan are revealed, that support has, in the past, dropped.

‘Heartbeat Bills’ Give State Lawmakers Pause On Anti-Abortion Tactics

In anticipation of a new anti-abortion tilt on the Supreme Court bench, some states are moving to further restrict the procedure during the first trimester of pregnancy or to outlaw abortion entirely if Roe v. Wade ever falls. But the rush to regulate has exposed division among groups and lawmakers who consider themselves staunch abortion opponents.

On Thursday, Ohio became the latest state to ban abortions after a fetal heartbeat can be detected. For a long time, Ohio Right to Life supported a more gradual approach to restrict the procedure and deemed what’s come to be called a “heartbeat bill” too radical — until this year. Restricting abortions after a fetal heartbeat can be detected basically bans the procedure after six weeks of gestation — before many women know they’re pregnant.

“We see the court as being much more favorable to pro-life legislation than it has been in a generation,” spokeswoman Jamieson Gordon said. “So we figured this would be a good time to pursue the heartbeat bill as the next step in our incremental approach to end abortion-on-demand.”

The Ohio law contains no exception for pregnancies that are the result of rape or incest; it does have an exception for the life of the mother.

Some say the rush to pass these bills is about lawmakers competing to get their particular state’s law before the Supreme Court. The state that helps overturn Roe v. Wade would go down in history.

More than 250 bills restricting abortions have been filed in 41 states this year, according to the Guttmacher Institute, a reproductive rights research and advocacy group.

“After the appointment of Justice [Brett] Kavanaugh, there really is just an environment in state legislatures to roll back abortion rights. And so we’re seeing these bans just fly through,” said Elizabeth Nash, who monitors state laws at Guttmacher.

But the speed of passage of some of these laws masks divisions about strategy and commitment to the cause within the anti-abortion movement.

Tennessee Infighting Over ‘Heartbeat Bill’

In Tennessee, for instance, there’s a philosophical split between pragmatists and idealists.

A “heartbeat bill” in the state has had high-profile support, including from the Tennessee’s new governor. But the Republican attorney general warned such a law would be difficult to defend in court. And several Republicans, swayed by that logic, voted no for the legislation.

“This is an issue that is extremely important to me. It’s the reason I got into politics many years ago,” Republican state Rep. Bill Dunn said as the House approved the measure over his objection earlier this year. Dunn has said he wants to stop abortion, but that will require strategy. He pointed out that no heartbeat bill has ever been enforced. And recent laws in Iowa and Kentucky have been immediately blocked in court. The same is expected for Ohio.

“No. 1, it’ll probably never save a life if we go by what’s happened in the past,” Dunn argued on the Tennessee House floor.

But it was money that ultimately stopped the heartbeat bill this year in Tennessee. (It stalled in committee last week, though the state’s Senate Judiciary Committee agreed to review the bill this summer.)

Senate Speaker Randy McNally, who also opposes abortion, said he has no interest in wasting tax dollars to make a point.

Even worse, in the view of Republicans who voted against the heartbeat bill, the state could end up paying the legal fees for groups that defend abortion.

“That is a big concern,” McNally said. “We don’t want to put money in their pockets.

The last time Tennessee had a case that went to the U.S. Supreme Court, it cost roughly $1.9 million. The experience was enough to give a few anti-abortion crusaders some pause. They voted last week with Democrats for a one-year delay on a heartbeat bill, vowing to study the issue over the summer.

Name-Calling In Oklahoma

Even if it doesn’t result in a case that upends abortion law, heavily Republican legislatures like Oklahoma’s want to be ready.

“If Roe v. Wade ever gets overturned, we won’t be prepared,” Republican Senate Pro Tempore Greg Treat said while explaining his so-called trigger bill at a committee hearing in February.

Treat’s legislation, modeled after existing laws in a handful of states, would “trigger” a state ban on abortion and make it a felony if Roe were overturned. A handful of states, including Arkansas, Kentucky, Louisiana, Mississippi, North Dakota and South Dakota, already have trigger laws on the books.

Oklahoma has some of the strictest abortion laws in the nation, such as mandatory counseling and a 72-hour waiting period. But the most conservative anti-abortion activists in the state want more immediate action. So they targeted Treat and other self-described “pro-life” Republicans with protests, billboards and flyers, accusing them of not being anti-abortion enough.

“I’ve been called every name in the book these past few weeks,” Treat said. “I’ve had my Christianity questioned. I’ve had a member of my own caucus hold a press conference and call me a hypocrite.”

In response, Treat abandoned the trigger bill.

Now he’s trying something else — an amendment to the state constitution that would reinforce that nothing in Oklahoma law “secures or protects” the right to abortion. But that’s still not anti-abortion enough for some.

“It’s going to add on to that legacy that we have of death and just status quo pro-life policy that does nothing,” said Republican state Sen. Joseph Silk.

Not Far Enough In Georgia

In Georgia, a “heartbeat bill” passed the legislature, but has paused at Republican Gov. Brian Kemp’s desk. Supporters of abortion rights don’t want him to sign it, of course, but some anti-abortion activists aren’t happy either.

“It really just does not go far enough in the protection of innocent human life,” said Georgia Right to Life executive director Zemmie Fleck. Fleck argued that certain exceptions in his state’s bill — for abortions after rape or incest if the woman makes a police report — weaken it.

Gov. Kemp has until May 12 to sign or veto the measure.

Cost As No Object In Kentucky

The American Civil Liberties Union in Kentucky sued the day after a “heartbeat bill” was signed into law by Republican Gov. Matt Bevin. But even during his annual speech to the Kentucky legislature in February, Bevin acknowledged his intent to challenge Roe v. Wade.

“Some of these will go all the way to the U.S. Supreme Court. But at the end of the day, we will prevail because we stand on the side of right and we stand on the side of life,” Bevin said.

Kentucky has become accustomed to defending abortion restrictions in court. Currently, one law that makes it a felony for a doctor to perform a common abortion in the second trimester has been suspended indefinitely.

It is unclear how much it costs Kentucky to defend abortion laws that are immediately challenged. In an emailed statement, Bevin administration spokesman Woody Maglinger wrote that the state is using in-house lawyers, and hasn’t hired outside counsel. He declined to provide a cost estimate on hours spent on these cases.

“It is impossible to place a price tag on human lives,” Maglinger wrote.

This story is part of a partnership that includes Nashville Public RadioNPR and Kaiser Health News.