- How to Get Rid of Canker Sores
- Repealing Obamacare is More Complicated Than It Looks
- Millions on Medicaid Could Lose Coverage Under Trump
- Record Number of People Sign Up for Obamacare After Donald Trump Elected President
Posted: 11 Nov 2016 06:52 AM PST
Canker sores are frustrating and painful. If you find you’re getting canker sores often, the solution may be as simple as avoiding spicy foods or acidic fruits, which can irritate the mouth. Also, try brushing and flossing right after meals to help remove food particles stuck between your teeth. And stop using any toothpastes or mouth rinses that contain sodium lauryl sulfate, a chemical that can be harsh on soft tissue, potentially causing canker sores.
Health.com: The Best and Worst Foods for Your Teeth
If you have stubborn sores, you could be deficient in certain nutrients, such as folate, iron, or vitamin B12. Make sure you’re eating a well-balanced diet (you can get folate from beans and vegetables such as spinach and broccoli, and iron and B12 from tuna and eggs, among other foods). Consult your doctor if you think you need a supplement. Stress can also trigger the sores, so getting plenty of sleep and finding ways to tame tension may help prevent them. Less frequently, canker sores can be linked to conditions like inflammatory bowel disease (such as Crohn’s and ulcerative colitis) and HIV. So if lifestyle adjustments don’t make a difference, it’s worth seeing a doctor.
Notice a canker sore developing? Try gargling with salt water. You can also apply an over-the-counter topical ointment directly on the sore to ease pain. Usually canker sores hurt for only a few days and go away completely in a week or two. But if you have a severe, painful one, your doctor may prescribe a special mouth rinse or corticosteroid ointment.
Health’s medical editor, Roshini Rajapaksa, MD, is assistant professor of medicine at the NYU School of Medicine.
Posted: 10 Nov 2016 01:41 PM PST
After six controversial years, the Affordable Care Act may be on the way out, thanks to the GOP sweep of the presidency and both houses of Congress Tuesday.
Senate Majority Leader Mitch McConnell (R-Ky.) said Wednesday that repealing the law is something that’s “pretty high on our agenda.” But promising to make the law go away, as President-elect Donald Trump did repeatedly, and actually doing it, are two different things.
“Washington is much more complicated once you’re here than it appears to be from the outside,” said William Pierce, a consultant who served in both the George W. Bush Department of Health and Human Services and on Capitol Hill for Republicans.
For example, a full repeal of the health law would require 60 votes in the Senate to overcome a filibuster. Given the small GOP majority in the Senate, “they would have to convince six or eight Democrats to come with them to repeal. That seems highly unlikely,” Pierce said.
Republicans could possibly use a budget procedure to repeal broad swaths of the law. The “budget reconciliation” process would let Republicans pass a bill with only a majority vote and not allow opponents to use a filibuster to stop movement on the bill.
But that budget process has its own set of byzantine rules, including one that requires that any changes made under reconciliation directly affect the federal budget: in other words, the measure must either cost or save money. That means “they can only repeal parts” of the law, said Pierce.
Republicans have a ready-made plan if they want to use it. The budget bill they passed late last year would have repealed the expansions of Medicaid and subsidies that help low- and middle-income families purchase health insurance on the law’s marketplaces, among other things. President Barack Obama vetoed the measure early this year.
That bill also included, as Vice President-Elect Mike Pence promised in a speech last week in Pennsylvania, “a transition period for those receiving subsidies to ensure that Americans don’t face disruption or hardship in their coverage.” The bill passed by the GOP Congress at the end of 2015 set that date at Dec. 31, 2017.
Delaying the repeal date could work in Republicans’ favor, said insurance industry consultant Robert Laszewski. “Then they’ll turn to the Democrats and say, ‘Work with us to replace it or be responsible for the explosion,’” he said.
But Tim Westmoreland, a former House Democratic staffer who teaches at Georgetown Law School, said that strategy won’t work. “I don’t think people will see the Democrats as responsible if it all blows up,” he said.
Meanwhile, Republicans have only the broadest outlines of what could replace the law. Trump’s campaign website has bullet-point proposals to allow health insurance sales across state lines and to expand health savings accounts — which allow consumers to save money, tax-free, that can be used only for health care expenses. House Republicans last summer offered up a slightly more detailed outline that includes creating “high-risk pools” for people with preexisting health conditions and turning the Medicaid program back to state control through a block-grant program.
Yet even Democrats are convinced that Obama’s signature accomplishment is on the chopping block. “A lot of people say, ‘Oh, they can’t really mean it. They wouldn’t really take health insurance away from 20 million people’” who have gained it under the law, John McDonough, a former Democratic Senate staffer, said at a Harvard School of Public Health Symposium last week. “How many times do [Republicans] have to say it before we take them seriously?”
One possibility, according to William Hoagland, a former GOP Senate budget expert now at the Bipartisan Policy Center, a Washington-based think tank, is that Republicans could use the budget process to combine tax reform with health policy changes. “And a reconciliation bill that includes reforms in Obamacare and tax reform starts to become a negotiable package” that could attract both Republicans and potentially some Democrats, who are also interested in remaking tax policy.
But if Congress does pass the GOP’s “repeal” before the “replace,” it needs to make sure that insurers will continue to offer coverage during the transition.
“Are [Republicans] going to invite insurers in and listen?” said Rodney Whitlock, a former House and Senate Republican health staffer. If there is no acceptable transition plan, “insurers can say the same thing to the Republicans that they’ve been saying to Democrats,” said Whitlock, which is that they are leaving the market.
That’s something that concerns insurance consultant Laszewski, who says that already there are more sick than healthy people signing up for individual coverage under the law. With probable repeal on the horizon, he said, that’s likely to get even worse. “A lot of [healthy] people will say, ‘Why sign up now? I’m going to wait until they fix it.’”
And if that happens, he said, there might not be any insurers offering coverage for the transition.
Posted: 10 Nov 2016 01:30 PM PST
Millions of low-income Americans on Medicaid could lose their health coverage if President-elect Donald Trump and a Republican-controlled Congress follow through on GOP proposals to cut spending in the state-federal insurance program.
The biggest risk for Medicaid beneficiaries comes from pledges by Trump and other Republicans to repeal the Affordable Care Act, which provided federal funding to states to expand Medicaid eligibility starting in 2014. Thirty-one states and Washington, D.C. did so, adding 15.7 million people to the program, according to the government. About 73 million are now enrolled in Medicaid—about half are children.
Reducing the number of people in Medicaid while ensuring that only the most needy remain eligible will be a goal for Trump and the new Congress, said Brian Blase, senior research fellow at the conservative Mercatus Center at George Mason University in Virginia.
“If we do not have fewer people in Medicaid in four years, then we have not reformed health policy in a good direction,” he says.
But there are obstacles to the Republicans’ plans. Medicaid, created in 1965, is the nation’s main health insurance program for low-income people.
Overhauling it is politically difficult because of the potential harm to recipients as well as the financial consequences to states, hospitals, doctors and other health providers, who might not get paid for their services if patients don’t have coverage. Total Medicaid spending was $532 billion in fiscal 2015, with about 62 percent funded by the federal government.
One major change endorsed by both Trump and House Speaker Paul Ryan (R-Wis.) would transform Medicaid from an entitlement program into a block grant program.
Here’s the difference between the two: In an entitlement program, coverage is guaranteed for everyone who’s eligible. The federal government’s commitment to help states cover costs is open-ended. The states’ obligation is to cover certain groups of people and to provide specific benefits. Children and pregnant women who meet specific income criteria must be covered, for example.
That formula would change if federal funds flow to states through block grants. States would have more flexibility to run their Medicaid programs as they wish, including cutting benefits and eligibility. And proponents say it would allow the federal government to spend less on Medicaid and make states responsible for covering costs beyond their federal allotments.
Turning Medicaid into a block grant program has been discussed for more than 25 years, but the idea has always met resistance from some states, health providers, health care advocates and Democrats. Even with a Republican majority in Congress and Trump in the White House, the plan would still face an uphill legislative battle.
The federal government rarely shifts power to the states and not all states want to be at increased financial risk for the program.
“Medicaid block grants face a very uncertain future,” said Joel Cantor, director of the Center for State Health Policy at Rutgers University in New Jersey.
Another option to redefine Medicaid funding, similar to a block grant, is known as a per capita cap. States would be given a set amount of money per enrollee, which would increase each year but critics fear likely not keep up with rising health expenses. That method would help states better deal with growing enrollment because funding would rise, too.
Even without help from Congress, Trump’s administration could change Medicaid using the executive branch’s power to approve states’ requests for waivers from federal rules. That could allow Trump to approve changes proposed by Republican governors that the Obama administration has rejected, including work requirements for Medicaid enrollees and monthly premiums and other cost-sharing.
Trump could also end some waivers that expanded Medicaid and sent billions in new federal funding to some states that transformed care.
Any congressional changes to Medicaid next year would likely include negotiations about the Children’s Health Insurance Program, another federal-state program that provides coverage to youngsters whose families are slightly over the Medicaid eligibility. The program expires if not reauthorized by Sept. 30, 2017. According to the Kaiser Family Foundation, about 8 million children get coverage through CHIP, which has had Republican and Democratic support.
After Trump is in office, he may find it’s harder than he realized to repeal Obamacare and tinker with Medicaid because cutting off coverage for millions of people could bring plenty of political fallout, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
Republican Gov. Matt Bevin of Kentucky took a similar tack last year, she observed, running against Obamacare and vowing in his campaign to eliminate the expansion. He has since proposed major changes to Medicaid, but he has not yet moved to kill the expansion.
Still, Alker said Trump’s win puts the block grant idea front and center in January. And an agreement to do it could give states flexibility to make cuts in federally required benefits, such as health screenings for infants and children.
Posted: 10 Nov 2016 11:47 AM PST
More than 100,000 people signed up for coverage under the Affordable Care Act on Wednesday, the highest since Open Enrollment began Nov. 1, according to the Obama administration.
Health and Human Services Secretary Sylvia Burwell announced the record number of people who enrolled and selected a health plan in a tweet Thursday. The high volume of sign-ups occurred right after election day, as Donald Trump has pledged to repeal Obamacare when he’s President.
“Clearly, health insurance on the Marketplace is a product people want and need,” Health and Human Services spokeswoman Juliet Johnson told USA Today.
Senate Majority Leader Mitch McConnell said Wednesday that Republicans plan to repeal Obamacare.
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