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To Your Good Health: Will Miracle Fruit bring back sense of taste?





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For Millennials, Both Good And Bad News In Senate’s GOP Health Bill

Darlin Kpangbah receives free health insurance through Medicaid and is grateful for the coverage in case of accidents, such as when she tore a ligament in her leg a few years ago. “I feel like I’m injury-prone,” said Kpangbah, 20, who lives in Sacramento, Calif. Without insurance, she said, the injury “would’ve been huge to pay for.”

Young adults like Kpangbah were among the biggest beneficiaries of Obamacare, which helped reduce the rates of uninsured millennials to record lows and provided millions of Americans with access to free or low-cost insurance as well as maternity care, mental health treatment and other services.

Now, Senate Republicans have proposed overhauling the Affordable Care Act — a move that could help some young adults by lowering the cost of their premiums in the private insurance marketplaces but could hurt others who gained insurance through a massive expansion to Medicaid. A Congressional Budget Office analysis of the bill released Monday estimated that 22 million Americans could lose coverage under the Senate bill, which could change significantly before an expected vote before July 4.

The proposed legislation also would retain a popular Obamacare provision that allowed young adults up to age 26 to stay on their parents’ insurance. But the bill in its current form also could dramatically reduce health coverage and care for other young adults, according to the bill’s many critics, which include the American Medical Association and the American Hospital Association.

“Don’t be fooled,” said Jen Mishory, executive director of the advocacy organization Young Invincibles. “This is going to be a bad deal, particularly for the most vulnerable young people.”

Mishory said one of the biggest concerns is that states could opt out of requiring insurers to provide benefits such as maternity care, mental health care and prescription drugs — all commonly used among young adults. “You will see a lot of young people not getting the kind of coverage they need,” she said.

The proposed changes in the marketplaces, however, could make coverage more attractive to young people. The Congressional Budget Office reports that the Senate bill would result in a larger number of younger people paying lower premiums to buy private plans. The proposal would allow insurers to charge older people up to five times more than others, which could mean lower premiums for younger people.

At the same time, the Senate bill shifts the amount people who qualify for subsidies must pay toward their own premiums, meaning that people under age 40 might pay a smaller portion of their income toward coverage than they do under Obamacare.

But young adults could face other cost increases because of larger deductibles and less help with out-of-pocket expenses. Some no longer would qualify for subsidies at all, because the bill would reduce the income threshold for eligibility.

Millions of young adults have enrolled in coverage through the insurance exchanges, in part because of a coordinated push to get as many healthy, young people into the marketplace to balance out older, sicker consumers who were eager to sign up right away.

About 27 percent of the 12.2 million consumers who enrolled in health insurance through the exchanges across the nation in 2017, were 18 to 34 years old. In California, 37 percent of 2017 enrollees were in that age group, according to Covered California, the state’s insurance exchange.

Steven Orozco, who lives in Los Angeles, is among them. He, his wife and 2-year-old daughter have a plan through Covered California. Orozco, who is a real estate agent, said they are all healthy so they don’t use it often, but he has it just in case of broken arms or other unexpected health needs.

Orozco, 32, said that he is concerned about what could happen in Washington and how that might affect his coverage, which currently costs about $450 a month.

Despite potential benefits to young adults in the private marketplace, the most damaging changes under the Senate proposal would be for young adults covered by Medicaid, said Walter Zelman, chairman of the public health department at Cal State-Los Angeles.

In addition to phasing out the expansion of Medicaid, the Senate bill also would result in reduced funding for the program, he said.

“The biggest impact on young people is the dismantling of Medicaid,” Zelman said.

Since the Affordable Care Act took effect, about 3.8 million young adults have gained coverage through the expansion of Medicaid, according to Young Invincibles.

In California alone, Zelman said, hundreds of thousands of young people won’t be able to access Medi-Cal, California’s version of Medicaid, if the expansion is phased out. Zelman, who worked to enroll California State University students into health coverage under Obamacare, said that historically the highest percentages of uninsured people have been young adults, low-income residents, part-time workers and Latinos.

“Those are my students,” he said. “And, more generally, those are young people overall. … Anything that threatens [their] access to health is bad for them,” he said.

It’s unclear whether the proposed Republican overhaul would result in more or fewer young enrollees.

Uninsured Sacramento resident Sydney Muns, 27, works at a nonprofit that doesn’t offer health coverage, and she earned too much money to qualify for Medi-Cal or receive Obamacare subsidies. Muns said she hopes premiums and out-of-pocket costs will decline in the future so she can get coverage.

“It’s just not affordable,” said Muns, who faces $50,000 in college loan debt. “I don’t know anyone my age who has insurance.”

But Chyneise Dailey, 24, said she plans to purchase health care whether or not she is required to do so. Dailey, who works at Sacramento State, remains on her parents’ Blue Cross health insurance plan, but knows she has only a couple of years before she has to buy her own coverage.

“You never know what can happen. You get into a car accident, you’re in the ER — do you want to pay full rate or do you want to pay your copay?” Dailey said. “I’d just rather be safe than sorry.”

Under both the Senate and House plans to overhaul Obamacare, young women who go to Planned Parenthood for reproductive health and other medical services could be hurt because of a provision to ban federal funding of the organization for a year.

That concerns Niki Kangas, 35, who frequently visits Planned Parenthood clinics even though she has job-based coverage from Kaiser Permanente. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.) Kangas, of Sacramento, said she is “pissed off” that the Senate’s proposed bill would impose a one-year ban on federal funding to the organization, which is a frequent target for conservatives.

“I’ve used Planned Parenthood a lot, either in between jobs or sometimes it’s just more convenient than going out to Kaiser, like if I just need birth control,” said Kangas, a project manager at a design agency. “I think for people who don’t have insurance through their work that it’s a resource they depend on.”

Mary Agnes Carey, Julie Appleby and Barbara Feder Ostrov contributed to this report.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. KHN’s coverage in California is funded in part by Blue Shield of California Foundation.

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

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The Latest: McConnell says good progress made on health bill

WASHINGTON — The Latest on the Republican legislation overhauling the Obama health care law (all times EDT):

5:55 p.m.

Senate Majority Leader Mitch McConnell says “good progress” was made during a White House meeting between President Donald Trump and Republican senators.

Trump invited them to meet after McConnell decided to delay a vote on a Senate health care bill because there aren’t enough votes to pass it.

McConnell said after the meeting there’s a “really good chance” of passing the bill, but it won’t happen before July Fourth as he originally planned.

McConnell says Republicans must come up with a solution because that’s why the American people elected them. He says negotiating with Senate Democrats won’t produce any of the changes sought by Republicans, including to the health markets and Medicaid.


4:35 p.m.

President Donald Trump says that if the health care bill fails to pass in the Senate, he won’t like it — but “that’s OK.”

Trump spoke Tuesday at a gathering of Senate Republicans after their leaders shelved a vote on their prized health care bill until at least next month.

Trump says, “This will be great if we get it done and if we don’t get it done it’s going to be something that we’re not going to like and that’s OK and I can understand that.”

He adds, “I think we have a chance to do something very, very important for the public, very, very important for the people of our country.”


4:30 p.m.

Add three more names to the list of Republican senators saying they oppose the GOP health care bill.

But these three get an asterisk. They released statements of flat-out opposition after Senate Majority Leader Mitch McConnell said he was delaying the vote in hopes of rounding up enough support for passage.

Sens. Rob Portman of Ohio and Shelley Moore Capito of West Virginia have persistently criticized the bill’s cuts in Medicaid, and have sought billions more to combat opioid abuse. Both said for the first time Tuesday they opposed the measure.

Sen. Jerry Moran of Kansas said last week he would examine whether the proposal was good for his state. He said Tuesday the bill did not have his support, saying he wanted more affordable and better quality health care.


4:25 p.m.

President Donald Trump says he wants the replacement of the 2009 health insurance law to increase the number of insurance coverage choices and lower premiums, a senior White House official says.

The president was stressing these goals in a meeting Tuesday with Kentucky Sen. Rand Paul, a Republican who opposes the Senate’s planned replacement of the government’s health insurance expansion under former President Barack Obama. The official insisted on anonymity to describe private conversations.

Senate Majority Leader Mitch McConnell of Kentucky has delayed a vote on that replacement, which has been unable to attract sufficient support from Republican lawmakers. The replacement would reduce funding for Medicaid, cut taxes on investments and cause 22 million fewer people to no longer have health insurance, according to the Congressional Budget Office.

— Josh Boak


4:20 p.m.

President Donald Trump and Vice President Mike Pence are hosting Republican senators at the White House to discuss flailing efforts to pass a new health care bill.

Most of the GOP senators arrived at the White House Tuesday after Senate Republican leaders shelved a vote on their prized health care bill Tuesday until at least next month.

A GOP rebellion left them lacking enough votes to even begin debate.

Trump said Tuesday that “we’re getting very close but for the country we have to have health care.”

Trump invited the GOP senators for a meeting in the East Room to discuss efforts to repeal and replace former President Barack Obama’s signature health care bill.

He says “I think the Senate bill is going to be great.”


2:40 p.m.

Senate Majority Leader Mitch McConnell says he is delaying a vote on a Senate health care bill while GOP leadership works toward getting enough votes.

He says they are “still working toward getting at least 50 people in a comfortable place.”

Republican senators are headed to the White House Tuesday afternoon to talk to President Donald Trump about the future of the bill.

McConnell says the White House is “very anxious to help” and encouraged senators to go to the meeting.

McConnell said health care is “a big complicated subject,” and complicated bills are “hard to pull together and hard to pass.” He told reporters on Tuesday that he was very optimistic.


1:50 p.m.

Sources tell the Associated Press that Senate Republican leaders have abruptly delayed the vote on their health care bill until after the July 4th recess.

That’s the word Tuesday as the GOP faced five defections from its ranks just hours after the Congressional Budget Office said the bill would force 22 million off insurance rolls.

It was a major blow for the seven-year-old effort to repeal and replace Barack Obama’s Affordable Care Act.

Separately, President Donald Trump has invited all GOP senators to the White House Tuesday afternoon.


1:10 p.m.

New analysis shows that millionaires would get tax cuts averaging $52,000 a year from the Senate Republicans’ health bill.

Middle-income families would get about $260.

The analysis was done by the nonpartisan Tax Policy Center. It found that half of the tax cuts would go to families making more than $500,000 a year.

At the other end, families making $20,000 a year would, on average, get a $190 tax cut.

The Republican health bill would repeal and replace President Barack Obama’s health law. The law imposed a series of tax increases mainly targeted high-income families. The Senate Republican bill would repeal the taxes, though not all at once.


12:20 p.m.

Major veterans’ organizations are voicing concerns about a Senate Republican bill to repeal the nation’s health care law. They fear the impact of rising insurance costs and are worried the underfunded Department of Veterans Affairs won’t be able to fill the coverage gap.

Paralyzed Veterans of America is one of the six biggest nonpartisan veterans’ groups. In a letter to senators Tuesday, it criticized an “opaque and closed” legislative process and proposed cuts to Medicaid that could lead to hundreds of thousands of lower-income veterans losing their insurance.

The organization joins a Democratic-leaning group, VoteVets, in opposing the bill. VoteVets launched a six-figure ad campaign in two states to pressure senators.

Disabled American Veterans and AMVETS also are expressing concern about the Senate legislation backed by President Donald Trump.


11:45 a.m.

One of a handful of Republican senators opposing the Senate health care bill is headed to the White House to talk with President Donald Trump about the measure.

Kentucky Sen. Rand Paul tweeted about his visit, saying he was: “Headed to meet with @realDonaldTrump this afternoon.” He added that the current bill is “not real repeal and needs major improvement.”

Paul has said it is worse to “pass a bad bill than to pass no bill.”

Senate leaders are scrambled to rescue their health care bill in the face of defections after Congress’ nonpartisan budget office said the measure would leave 22 million more people uninsured by 2026 than President Barack Obama’s health care law.

Senate Majority Leader Mitch McConnell has been aiming to win Senate passage for the bill his week.


11:34 a.m.

The New York attorney general is threatening to file a lawsuit to block the implementation of a Republican health care overhaul.

Attorney General Eric Schneiderman said Tuesday that the evolving Senate bill violates women’s constitutional rights by de-funding Planned Parenthood. It also violates New York’s state’s rights, he said, by targeting a New York-specific Medicaid provision.

Schneiderman said, “If the version of the health care bill proposed last week ever becomes law, I am committed to going to court to challenge it to protect New Yorkers from these wrong-headed and unconstitutional” policies.

The Democrat made the comments in a speech to state business leaders. He later said his office is “doing the research” to prepare for possible litigation.

Senate Republican leaders planned to pass the bill this week, but so far lack the votes to take up the measure.


11:20 a.m.

Utah Sen. Mike Lee has become the fifth Republican senator to oppose starting debate on the GOP health care bill. That deals another blow to party leaders hoping to push the top-priority measure through the Senate this week.

Lee was among four conservative senators who announced last week they oppose the bill’s current version. Lee spokesman Conn Carroll said Tuesday that the lawmaker will not vote for a crucial procedural motion allowing the Senate to begin debate on the legislation, unless it’s changed.

Senate Majority Leader Mitch McConnell can lose the votes of only two of the 52 Republican senators to begin debate and ultimately pass the bill. All Democrats oppose it.

Lee has favored a fuller repeal of President Barack Obama’s health care law than the current GOP bill.


10:25 a.m.

House Speaker Paul Ryan says he has faith in Senate Majority Leader Mitch McConnell’s ability to round up the votes for the Republican health care bill despite growing opposition in the Senate.

Ryan told reporters on Tuesday: “I would not bet against Mitch McConnell.”

The Wisconsin Republican said he has every expectation that the Senate will move ahead on the bill, which the Congressional Budget Office says would kick 22 million off the insurance rolls. The bill would cut taxes, reduce the deficit and phase out the Medicaid expansion implemented by Barack Obama’s health law.

Ryan said every Republican senator campaigned on repealing and replacing Obama’s law.

The speaker said House members are waiting to see what happens in the Senate. The House could try to vote after the Senate to push the bill and get it to President Donald Trump before the weeklong July 4th recess.


7:45 a.m.

Senate Republican leaders are scrambling to rescue their health care bill. It’s in trouble as opposition from rebellious Republicans grows.

The defections came as Congress’ nonpartisan budget referee said the measure would leave 22 million more people uninsured by 2026 than President Barack Obama’s law, which Republicans are trying to replace.

Majority Leader Mitch McConnell, R-Ky., was hoping to staunch his party’s rebellion, a day after the Congressional Budget Office released its report. He’s been aiming at winning Senate passage this week, before a weeklong July 4 recess that leaders worry opponents will use to weaken support for the legislation.


4:02 a.m.

Congress’ nonpartisan budget referee says the Senate Republican health care bill would leave 22 million additional people uninsured in 2026 compared to President Barack Obama’s law.

And now, disgruntled centrist and conservative GOP senators are forcing Senate Majority Leader Mitch McConnell to scramble to rescue the measure before debate even begins.

The Kentucky Republican was hoping to staunch his party’s rebellion on Tuesday, a day after the Congressional Budget Office released its report. He plans to suggest revisions to the legislation in hopes of rounding up votes.

McConnell wants to win Senate passage this week. But three GOP senators are threatening to vote against a procedural motion to begin debate, a vote expected Wednesday. To be approved, no more than two of the 52 GOP senators can vote against it.

Copyright 2017 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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The Good, the Bad, and the Senate Health-Care Bill

The health-care bill now before the Senate has been shaped by a number of lessons that Republicans have learned in the course of a six-month, bicameral legislative process. It is a function of some things they’ve come to prioritize about the individual health-insurance market and Medicaid, and some things they’ve learned about the intricacies of the Byrd rule and Senate procedural constraints. But mostly it is a function of something they have learned about themselves: After seven years of saying they want to repeal and replace Obamacare, congressional Republicans have been forced to confront the fact that many of them, perhaps most, actually don’t quite want to do that.

That doesn’t mean that most of them never did. The case for repeal was strongest in the three or four years between the enactment and implementation of Obamacare. As more time passes since the beginning of implementation three and a half years ago, and more people’s lives become intertwined with the program for good and bad, the case for addressing Obamacare’s immense deficiencies by repeal weakens as a practical matter in favor of a case for taking them on by alteration. 

I don’t think it has weakened as much as congressional Republicans do. And so I still think it is very much the case that the cause of good policy (almost regardless of your priorities in health care) would be better served by a repeal and replacement, with appropriate transition measures, than by this sort of tinkering—you’d get more coverage, a better health-financing system, and a more appropriate role for government. 

Various conservative health-care wonks have proposed various ways of doing this over these seven years (I like this one, but I’m not objective, and most if not all would have made for serious improvements). Various Republican politicians have patted these wonks on the head and said “someday,” but everyone has understood that if and when an opportunity presented itself it would be shaped by its own unpredictable political exigencies. 

At first this year, congressional leaders tended to describe these exigencies in terms of the limits of the reconciliation process. But with each step it has turned out that reconciliation can bear much more than they first suggested. It is surely a constraint, but if the bulk of this Senate bill passes muster under the Byrd rule then reconciliation is not nearly as tight a constraint as it was said to be a few months ago. 

The president has been an additional unpredictable political constraint—as the more coherent of his musings on health care have all suggested he is not comfortable with repealing and replacing the law, or at least is unfamiliar with the tradeoffs involved and unhappy when he learns about them. This probably had some effect on congressional Republican attitudes, at least early on. But another thing Republicans have learned in these six months is that Donald Trump is an exceptionally weak president, probably the weakest of their lifetimes, and he is likely to accept whatever they do. He’ll celebrate it, sitting himself front and center while they stand around him awkwardly. He’ll praise it wildly and inaccurately. And he’ll sign it—even if pretty soon thereafter, in the wake of bad press, he tries to distance himself from it on Twitter and calls them names.  

So the most significant lesson Republicans have learned in this period is that what they—as a congressional conference guided by the sentiments of a majority of its members—want to do about Obamacare doesn’t begin with repeal. Whether they individually hold this view or not, congressional Republicans should not deny that this is the premise that they as a group have decided to start from, because the bill they passed in the House and the one they are now pursuing in the Senate wouldn’t make sense under any other premise. They are choosing to address discrete problems with Obamacare within the framework it created and to pursue some significant structural reforms to Medicaid beyond that, and they should want the merits of their proposal judged accordingly. Their premise is politically defensible—it is probably more so than my premise—and the proposal they have developed makes some sense in light of it. 

On the substantive particulars, I would say the bill is mostly better than the House version passed last month. We will see what CBO and other modelers ultimately say (understanding the limits of such modeling), but it seems to me it will probably cover more people, reduce premiums more, and allow for a greater reassertion of state regulatory control over health insurance. Better than the House bill isn’t extravagant praise, of course, but it is certainly one bar such a bill ought to clear. 

The tax credit in the Senate bill differs from Obamacare’s premium subsidies only modestly, but in ways that, again, make sense in light of what Republicans are after. It is pegged to a less comprehensive insurance model and will both cost less and leave more room for more variation in insurance design—though this obviously means it will be less valuable and helpful to some of the people now getting subsidies. Will less help in a more functional market be better than more help in a less functional market? There’s a good case to be made for that, but no one should pretend to know for sure. 

The credit also reaches all the way down to the bottom of the income scale, which I think of as an element of the bill’s Medicaid reform. Where today, people newly covered by Obamacare’s Medicaid expansion (who tend to be childless adults with relatively higher incomes than the non-expansion population) are funded by the federal government on much better terms than the traditional Medicaid population (which tends to include more women with children and people with even lower incomes), the Senate bill would gradually equalize funding for the two groups, effectively shifting Medicaid’s focus back to the most vulnerable of its beneficiaries. In states that respond to that by pulling back the expansion—and for states that have not pursued an expansion—the fact that the credit now goes all the way down means the Senate bill would provide an income and age-based subsidy that would allow these lowest-income individuals to afford at least modest insurance coverage in the individual market. 

That’s an improvement over the House bill and Obamacare, though I think it would make sense to provide some additional help to this lowest-income group. Some pre-funding of health savings accounts, for instance, could go a long way. The states could do that too, and should, but it’s not how congressional Republicans tend to think about the purpose of such accounts, alas. The portions of the conservative approach to health care that require spending public funds have never been as appealing as the rest on Capitol Hill. 

The bill’s broader Medicaid reform and the move to per-capita caps or (for states that choose them) block grants is otherwise very similar to that proposed by the House bill. It would take effect more gradually, though will ultimately also likely reduce federal spending more, but would follow the same basic structure. 

These Medicaid reforms probably won’t happen as written, because they are stretched out over a long span of time and yet are also highly controversial. But while the decline in the spending trajectory (which becomes particularly steep and unrealistic in the latter years of the budget window) would probably need to be moderated some by a future Congress, the structural reform would not be so easy to reverse—and any change would have to be paid for in ways that wouldn’t be so easy either. We will have to see how CBO scores the proposal, but eyeing it very generally I would say the Senate bill as written would probably mean that Medicaid would cost the federal government about 30 percent more 10 years from now than it does today (as opposed to about 65 percent more under current law), and would cover something like the same number of people at that point as today (as opposed to 10 million more under current law). All of that would be likely to change with future legislation, but the core structural reform—a move away from the horrendous state-match system—could well survive, and would be an important improvement almost regardless of spending levels.    

But the biggest change from the House bill, and from Obamacare, might prove to be the way in which the Senate bill tries to give states regulatory flexibility and control over the individual insurance market. Here we see how more explicitly embracing the premise of this legislation—that Republicans are not repealing Obamacare, but they are addressing some of its biggest problems—can actually enable them to move more aggressively rather than less. 

The federalization of health-insurance regulation is the core of Obamacare, and of the problem with it. The House bill sought to reverse it partially by allowing the states to obtain waivers from a couple of elements of Title I of the law—particularly the definition of essential health benefits, and the age-bands that govern how widely premiums can vary between younger and older people. The Senate bill pursues similar goals within the framework of Obamacare, by vastly expanding the range of permissible state waivers under Section 1332 of the law. 

Under Obamacare, these waivers technically allow states to pursue different insurance-regulation regimes, but they are very limited in scope because a state has to show that it would achieve exactly the same thing the federal Obamacare rules would achieve, which means states can’t really do anything all that different. The Senate bill removes most of these “guardrails” on the waivers, requiring only that a state show that its proposed alternative would not increase the federal deficit. So while a state could not, for instance, end community rating rules (because the 1332 waivers have to operate within the framework of community rating created by Obamacare), it could very significantly change other kinds of rules and requirements within its borders—to a far greater degree than anything the House waivers envisioned. And the bill requires that these waivers be more or less automatically approved. 

States could not only roll back essential health benefit definitions and broaden age bands to where they were before Obamacare, but also alter the uses to which federal dollars are put. They could take the amount their residents are eligible to receive in premium-subsidizing tax credits, for instance, and use it instead to create a new state benefit designed very differently. They could combine it with the stabilization fund dollars provided under this bill and with a state Medicaid reform to experiment with a different approach to providing access to insurance for their residents. They could alter the balance of benefits between younger and older people in the individual market, or change or eliminate the exchange in the state. If this were enacted, and once states got their bearings about just how much it would allow them to do, we could see some genuinely different approaches to health-insurance regulation among the different states—with blue and red models, rural and urban approaches, and more and less competitive systems. 

The limits of this provision are a function of the fact that it alters a portion of a broader pre-existing statute. But it is very broad. In its scope and structure, this redesigned waiver would be unlike anything else in American federalism—which also means we don’t know how it would work. Those of us inclined to look favorably upon a bottom-up, experimental mindset in policy design will be inclined to think the best of the possibilities here. I am very much in the grip of this prejudice myself. Those inclined to think the state governments are filled with bumbling fools while Washington overflows with subtle expertise will think the worst of this idea. But these different expectations are all rooted in roughly equal ignorance, and the results will probably be mixed enough to leave us all feeling mostly confirmed in our presuppositions in time—just as the performance of Obamacare has. But for better or worse, if this bill were enacted I think this waiver approach could prove to be one of its most significant elements in practice. 

Assuming, that is, that it survives the reconciliation process. And here to conclude we get to some big open questions about this bill that will need to be answered in the coming days if Republicans are able to bring it to a vote. Republicans began this process six months ago talking about the Byrd rule in the Senate as an immense obstacle to their ambitions. Now they are planning to take a bill to the floor of the Senate that assumes it to be a much lesser obstacle. And we will find out. One interesting test will be these expanded 1332 waivers. It’s not clear to me why they should pass muster with the parliamentarian, but their authors do seem very confident. 

Another Byrd rule question will surely arise over the Senate Republicans’ alternative to the 30 percent premium surcharge for people not continuously insured, that had been in the House bill. It was intended, in the absence of the individual mandate, to dissuade people from waiting until they are sick to buy coverage. In the version of the bill released last week, senators removed the surcharge but proposed no alternative and therefore did nothing to address the risk of adverse selection. If the version of this bill scored by the CBO is that version released last week, this will mean the score will be a total train wreck, and also largely useless to assessing the bill the Senate will ultimately vote on. It has since become clear that senators plan to add a provision to address this problem: subjecting people who have not been continuously insured to a six-month waiting period before they can buy coverage. In order to comply with the Byrd rule, I assume they will need to frame this provision as a delay in the availability of the tax credit, rather than an actual waiting period to buy coverage. Either way, it will be interesting to see if the parliamentarian allows it. 

A third and bigger Byrd rule problem will surely arise around the anti-abortion provisions in the bill. The Senate bill as released last week includes the House language imposing Hyde Amendment protections on the tax credit, so that it can’t be used to subsidize insurance that covers abortion. I think the likelihood that this provision will survive a Byrd-rule challenge is pretty much zero. 

But the bill also does something else: In creating the new state stability fund—to be used by the states for reinsurance or otherwise to shore up the individual market so badly damaged by Obamacare—it establishes the fund within the existing Children’s Health Insurance Program. CHIP was created in the 1990s, and the law that established it applies Hyde Amendment restrictions to the program in its entirety, and several times over. That means that, as a matter of statutory construction and placement, the new state stability fund would be covered by the Hyde Amendment without now having to get Hyde language past the parliamentarian. 

If this works it would establish a new kind of application for the Hyde Amendment language that has long prohibited federal dollars from paying for abortion in various programs. If I read it correctly, it looks like this provision would render any insurer who offers an individual-market plan that covers abortion in a given state ineligible to benefit from the stability fund in that state. It seems to me, though I can’t say I’m sure, that this would effectively mean that no insurance plans in the individual market would cover abortion. It could easily even mean that California, which has a state law requiring individual-market plans to cover elective abortion, would have to repeal that law or else forgo access to the stability fund. This, too, will prove quite a test of the Byrd rule, but I think the case for its qualifying for reconciliation is pretty strong. 

These are only a few of the more significant provisions of the Senate bill. But they suggest the pattern for any broader assessment of the bill. It is the product of a decision not to repeal Obamacare but to improve things where possible—moving incrementally in the direction of a more functional and more market-oriented system—within the framework Obamacare established. 

So while I don’t share the enthusiasm for this bill that my friend Avik Roy exhibits (and you should certainly read his view), I do think it is probably more good than bad on net—and could be readily improved and made more generous in years to come while retaining some important structural reforms and innovations, should further advances in Republican self-knowledge point in that direction. 

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Is Utah’s overall good health responsible for its high rate of Alzheimer’s disease?

By most measures of health, Utah is a good example for the nation, not a horrible warning. The Beehive State has some of the nation’s lowest rates of cancer, diabetes and heart disease. It has low rates of obesity, tobacco use and alcoholism.

But then there’s Alzheimer’s disease.

In the past five years, the number of deaths attributed to Alzheimer’s in Utah has more than doubled. Utah ranks 9th in the nation for Alzheimer’s deaths — compared with 50th for deaths from cancer and 35th from heart disease, according to the Centers for Disease Control and Prevention.

Moreover, Utah is one of six states in which cases of the degenerative brain disease are predicted to rise 40 percent or more over the next seven years.

Because the risk of Alzheimer’s disease and other forms of dementia increases as people age, the disease can seem like a curse of good health.

“It’s kind of a double-edged sword,” said Ronnie Daniel, executive director of the Utah chapter of the Alzheimer’s Association. “The single-largest risk factor for Alzheimer’s is age. People tend to have a more healthy lifestyle overall and that causes them to live longer here. But the longer we live, the more of a risk we have.”

Grim statistics seem to bear this out: One in 10 Americans over the age of 65 have Alzheimer’s. After age 85, 1 in 3 of us do. The average life expectancy in Utah is 80, one of the highest in the nation.

Centers for Disease Control and Prevention | Aaron Thorup, Centers for Disease Control and Prevention

If you live in a state where dementia-related deaths are rising, such as Arizona, Nevada and Utah, can you and your family opt out of the trend? With no vaccine or cure on the horizon, it may not be possible. Even people who are in peak physical health get Alzheimer’s, former President Ronald Reagan one of the most famous among them.

Although the Alzheimer’s Association says the disease cannot be prevented, treated or cured, accumulating research suggests that lifestyle factors can lower an individual’s risk, even as Alzheimer’s marches mercilessly among the population at large.

And some researchers believe preventive interventions can delay the onset of Alzheimer’s or slow its progression in people already showing signs of the disease. Four factors — nutrition, exercise and social and cognitive engagement — deliver the most promising results. For some of the more than 30,000 people currently living with Alzheimer’s in Utah, it’s too late. But others may be helped with the right interventions and if they keep other health conditions under control, health experts say.

‘There is absolutely nothing’

Dr. Terrell Thomson was a physician specializing in internal medicine for nearly three decades. The father of five also earned a doctorate in microbiology and, until recently, had the sort of brain that allowed him to retain anything he read. For fun, Thomson restored antique cars, including a 1937 Plymouth that his wife drove in American Fork High School’s 100th anniversary parade. He is an expert woodworker who made the mantel that hangs over the family’s fireplace in American Fork.

“Now opening a bottle of water is beyond his ability. He can’t drive. And he cannot play golf, which was his favorite thing,” said Debbie Thomson, now a full-time caregiver to her husband of 41 years.

Dr. Terrell Thomson has a medical degree, a Ph.D. and Alzheimer’s disease. He was diagnosed in January, and his wife Debbie is his caregiver. They pose Friday, June 23, 2017, next to a vintage 1937 Plymouth car that Terrell restored.| Eric Schulzke, Deseret News

Her husband, “the most brilliant man I have ever known,” was diagnosed in January at age 67 after more than three years of visual and cognitive decline.

“It is one of the most insidious diseases I can think of,” Debbie Thomson said. “With cancer, you have hope; there is some treatment, even if it isn’t effective. With this, there is nothing they have (to treat it). There is absolutely nothing.”

Even though her husband worked in health care for nearly 30 decades, the couple initially found it difficult to find help before seeing Dr. Norman Foster, a neurologist and director of the Center for Alzheimer’s Care, Imaging and Research at the University of Utah. Many doctors don’t want to get involved when a patient exhibits symptoms of Alzheimer’s, Debbie Thomson said, in part because they believe there’s nothing they can do.

One study published in 2015 found that nearly half of doctors treating patients with Alzheimer’s didn’t tell the patient of the diagnosis.

The perceived lack of effective treatment has created a sort of learned helplessness among many medical providers that is keeping patients from care that could help, said Daniel of the Alzheimer’s Association of Utah.

Dr. Terrell Thomson has a medical degree, a Ph.D. and Alzheimer’s disease. He was diagnosed in January, and his wife Debbie is his caregiver. They talk Friday, June 23, 2017, next to a vintage 1937 Plymouth car that Terrell restored. | Scott G Winterton, Deseret News

“Doctors tend to have that attitude that if there’s nothing I can do to help my patient, why should I burden them with this problem? It’s a big issue, getting doctors to understand that even if they can’t cure the disease, there’s a lot that can be done to help improve their quality of life,” Daniel said.

Another needed change is for primary-care doctors to start assessing cognitive abilities of their patients after 65, Daniel said. Even if no cognitive problems are detected, doing so provides a baseline that can make it easier to spot changes later on, he said, noting that Intermountain Health Care is now recommending that primary-care providers do routing screening for cognitive impairment at annual visits.

Dr. Meg Skibitsky, an Intermountain physician who specializes in geriatrics, said the health care company suggests that its providers offer a three-minute test called the mini-cog. The mini-cog assesses a person’s ability to draw a clock with a specific time shown and to remember a series of words. It doesn’t take much time, but the screening will help doctors who may not always be able to detect cognitive decline in a routine wellness visit, Skibitsky said.

“Unless dementia is really advanced and you’re really in tune to it, it can be missed by primary-care physicians. I have personally missed some of these diagnoses until I conducted screening tests,” she said.

If your doctor doesn’t do one, you should ask for the test if you or a loved one is 65 and older, Daniel said.

“It takes five minutes or less. And it’s no different from checking your cholesterol or heart rate every year,” he said.

Awareness and support

Americans fear cognitive decline more than they fear high cholesterol or high blood pressure. In a Marist Institute poll in 2012, people said they were more afraid of developing Alzheimer’s disease than having a stroke or getting cancer, heart disease or diabetes. There is a stigma unique to the disease, and it seems particularly prevalent in Utah, said Foster, the neurologist who diagnosed Thomson.

Foster was part of the statewide committee charged with implementing a five-year “action plan” to address the challenges presented by the 40 percent increase in Alzheimer’s cases that are expected in Utah by 2025.

But rates are spiking all over the U.S. The CDC reported recently that it expects nearly 14 million Americans to have Alzheimer’s by 2050, more than double the 5.5 million people diagnosed now.

Health officials say the numbers are disturbing, not just for the individuals who will suffer the loss of their memories and sense of self, as well as their families, but American taxpayers. More than two-thirds of the costs associated with care of people with Alzheimer’s and other forms of dementia are borne by Medicare and Medicaid, the Alzheimer’s Association says.

Utah’s state plan, which was supposed to exponentially increase Alzheimer’s awareness and research between 2012 and 2015, largely fizzled because it lacked funding, observers said. The plan had five overarching goals, including to make Utah “dementia aware” and provide support for caregivers, and 93 specific recommendations. But there was no state-provided funding until 2015, when the Legislature allotted $161,000 to hire an Alzheimer’s specialist in the state Department of Health and provide money for public information.

Daniel said his organization, which gets more than half of its funding through a series of Walks for Alzheimer’s each September, has made strides in support offered to families. The chapter trained more than 500 caregivers in 2016 and holds town-hall meetings, called “Dementia Dialogue,” across the state.

But medical professionals bemoan the lack of funding that they say hampers research nationwide. Even though cancer deaths have declined and Alzheimer’s deaths are spiking, more dollars are funneled into cancer study than dementia research. In 2016, the National Institutes of Health spent about $5.6 billion on cancer research; its budget for Alzheimer’s was $910 million.

While there are more types of cancer than there are dementia, the discrepancy frustrates many families who worry not only about a loved one who has Alzheimer’s, but future generations. Researchers have not been able to determine exactly what causes the disease, but first-degree relatives appear to have an increased risk, which worries the Thomsons and their five sons.

“There are so many people living with this. Even in our little neighborhood, I can count four people who recently or in the past have been diagnosed,” Debbie Thomson said. “And you ask yourself, What’s going on? Is there something else we can do? Do we have too many pollutants? There are no answers. We need more research.”

Things that can help

The Thomson family was devastated not only by the diagnosis, but by the speed with which Alzheimer’s took hold. Members of The Church of Jesus Christ of Latter-day Saints, Terrell and Debbie Thomson were four months into an 18-month mission in England when they realized they would have to return home because of Terrell Thomson’s deteriorating condition. In addition to Alzheimer’s, Thomson also has Balint’s syndrome, a neurological condition that affects vision.

Debbie Thomson said her husband had a strong social network and exceptional cognition until recently and was always challenging his brain, which is advice often given for Alzheimer’s prevention. “He read every night before bed,” she said.

Dr. Terrell Thomson has a medical degree, a Ph.D. and Alzheimer’s disease. He was diagnosed in January, and his wife Debbie is his caregiver. They pose Friday, June 23, 2017, next to a vintage 1937 Plymouth car that Terrell restored. | Scott G Winterton, Deseret News

But he had a heart attack more than a decade ago, and because of his demanding work schedule did not exercise regularly or get sufficient sleep. It wasn’t unusual for him to work 24-hour shifts, and he was always available to his patients day and night, his wife said.

“One of our sons said something that I thought was significant. He said, ‘Dad’s been awake more hours in his life than most people have at 90,’ and that’s probably a true statement,” Thomson said.

Researchers have known since 2009 that mice that are sleep-deprived develop the sticky plaques that are associated with dementia. Doctors speculate that the brain doesn’t have sufficient time to renew itself when people don’t get enough sleep.

Numerous studies have shown an association between exercise and improved cognition, even among people who have been diagnosed with Alzheimer’s. Benefits are seen not just with vigorous workouts, but with as little as a one-hour walk three times a week, The New York Times recently reported.

Researchers speculate that exercise helps by increasing the flow of blood to the brain. They also believe exercise helps the brain maintain neural connections and stimulates the growth of new ones, according to the National Institutes of Health.

In addition, some medical experts believe that diets high in fish and vegetables provide protection against dementia’s onset and progress. And a recent study in the United Kingdom found a greater risk of dementia among people who drink alcoholic beverages in moderation.

Although the predictions for Alzheimer’s spread in the coming decades seem dire, Foster said people shouldn’t become discouraged and think there’s nothing they can do to mitigate their risk. He noted a report last year that came out of the renowned Framingham Heart Study, a multigenerational study of people in Framingham, Massachusetts, that showed the risk of Alzheimer’s and other forms of dementia declined when people had regular treatment for high blood pressure and diabetes.

“For individuals who didn’t get those controlled, the rates (of dementia) were exactly the same as they were 30 years ago,” he said.

“The big news is that we can do something to decrease the rate or individuals’ risk of Alzheimer’s. There are many things we can do that will help, but it requires both health care providers, as well as patients and their families, to actively take these steps,” Foster said.

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Be the hare and win the race to good health

Editor’s note: Adam Rees is founder, owner and head coach of GRIT Gym, a gym based on results, creating a culture and lifestyle of performance, strength, health and freedom.

The tortoise and the hare. We all know the story. Slow and steady wins the race.


Slow and steady never wins the race. Not once has slow and steady won the race.

It doesn’t matter if it’s a sprint, marathon or even an ultra marathon. The one who finishes the fastest wins. Always. No matter what.

The story isn’t about the benefits of going slow and steady. The story is about underestimating your opponent.

Society tells us “what’s the hurry? Slow down. Don’t rush. Take it easy. Slow and steady wins the race.”

This is poor thinking.

You need to be in a hurry — to get to the gym, to finish your workout, to make a decision and to accomplish your goals.

Consider this, you are the hare and your fears and doubts are the tortoise. You are faster and you will win every time if you do not slow down and procrastinate.

Our fears and doubts feed on time. That’s what keeps them alive. Starve them out. The more time you spend focused on them, the more they will grow and stay close to you. But if you don’t slow down, if you are in a hurry to finish the race, if you move fast … you will win.

Think about what kind of people are in the front of the pack in a race and think about what kind of people are dragging along at the back. The people at the front have the courage to be all in and give it their absolute gut-wrenching best. And they are in a hurry to accomplish their goals as fast as they can. They have no time to spend feeding their fear-based truths. They are too focused on the present priority and being a winner.

It’s like climbing a mountain. It’s lonely at the top. Only the people who work their tails off and don’t let up on the pedal reach the top. They earn it and they are rewarded with an incredible view and an incredible life.

We don’t have to go at this alone, either. We can get a coach. I believe in coaching 100 percent. I have a coach for every area of my life that I want to improve. I have a strength coach, a sports psychology coach, a business coach, a relationship coach, etc. It’s easier to accomplish your goals when you have someone who has been there and done that.

You don’t have to make the same mistakes they did. They have expertise, knowledge, a call to action and a plan. They also keep you accountable and moving forward. They keep you focused on the present priority and help you transition to the next one.

We’re all going to make errors. Whether you make that decision now or it two months, you’re going to make mistakes. No matter what.

Acknowledge the error. Learn from the error. Move on.

Hurry up. Life’s not waiting around for you. It’s happening now.

Get up and get going.

Contact Adam Rees at

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Buhari will return in good health – Osinbajo

Acting President, Yemi Osinbajo,​ ​on Sunday prayed for President Buhari’s quick recovery and and safe return to Nigeria


​”T​he President still has a lot to do for Nigeria​”, ​Osinbajo ​said when a delegation led by the FCT Minister Muhammed Bello paid him Sallah homage at ​his official residence, ​Aguda House​.
“We are praying everyday and we know that​ ​God Almighty who we serve will bring our President back in good health and that he will serve this nation with the same determination and the same spirit of oneness, the same spirit that he has always serve this nation from when he was a young man.

“He will serve this nation and complete the period of his service in good health, in good shape and our country will be the better for it.’’

​Osinbajo stated that Buhari’s administration will do all it can to sustain Nigeria’s unity and stability to ensure speedy progress of the country.

​He charged all Nigerians to look beyond their ethnic or religious beliefs while dealing with each other in order to move the nation forward.

“Our unity is not negotiable. We should make sure that we remain united in order to enjoy the resources God has blessed Nigeria with.​ ​So many nations envy what we have as a nation.

“Your ethnicity does not matter and that is why for us, unity is so important that we must work together to make sure that our country is able to take care of the millions of people we govern​”.​

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Why Having Lots of Feelings Is Good For Your Health

Happiness isn’t the only emotion that can help you stay healthy as you age. How excited, amused, proud, strong and cheerful you feel on a regular basis matters, too. In a new study, people who experienced the widest range of positive emotions had the lowest levels of inflammation throughout their bodies. Lower inflammation may translate to a reduced risk of diseases like diabetes and heart disease.

Past research has shown that positive emotions may have an anti-inflammatory effect on the body, but the new study, published in the journal Emotion, looks at whether the range and variety of those feelings play a role as well. Evolution suggests that they would; drawing on the evolutionary advantages of ecosystems with plenty of biodiversity, researchers from the United States and Germany wondered if similar perks may exist for variety within the human emotional experience. Such a range may improve physical and mental health by “preventing an overabundance or prolonging of any one emotion from dominating an individuals’ emotional life,” they write.

The researchers asked 175 middle-age adults to keep a daily log of their emotional experiences for a month by recording how often and how strongly they experienced each of 32 different emotions: 16 positive (like being enthusiastic, interested and at ease) and 16 negative (such as being scared, upset, jittery and tired). Six months later, scientists tested their blood samples for markers of systemic inflammation, a known risk factor for many chronic health conditions and for early death.

Overall, people who reported a wide range of positive emotions on a day-to-day basis had less inflammation than people who reported a smaller range—even if their overall frequencies of positive emotions were similar. That was true even after researchers controlled for traits like extraversion and neuroticism, body mass index, medication use, medical conditions and demographics. (Surprisingly, a similar effect was not observed for the other end of the spectrum. It didn’t seem to matter for inflammation whether people regularly experienced many or only a few variations of negative emotions.)

MORE: Why Do People Cry?

Lead author Anthony Ong, professor of human development at Cornell University, suspects that people may be able to maximize these benefits by more closely examining their emotions. “When it comes to infusing more diverse positive emotions into our lives, it may turn out to be a simple daily practice of labeling and categorizing positive emotions in discrete terms,” he says. “Pay attention to your inner emotions and be able to mentally recognize situations that make you feel calm versus, say, excited.”

Despite efforts to control for outside factors, Ong acknowledges that there may be unforeseen reasons why people with a smaller range of positive emotions may have higher inflammation. The study was not able to show a cause-and-effect relationship, or even the direction of the association. “It could also be that people with higher inflammation, for some reason, may be the ones who tend to report lower levels of positive emotional diversity,” Ong says. More research is needed, but this study strengthens the link between many kinds of happiness and better health.

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Pcra and IGL to Launch a Campaign for Good Health, Behaviour and Fuel Conservation for Drivers

Team EnergyInfraPost 

Petroleum Conservation Research Association (PCRA), the national government agency engaged in promoting energy efficiency in various sectors of economy and Indraprastha Gas Limited (IGL), the largest CNG distribution company of the country engaged in supply of CNG and PNG in Delhi along with adjoining cities of Noida, Greater Noida and Ghaziabad have joined hands to launch a mega campaign for public transport drivers of the capital.

The campaign is also being supported by Delhi Police. The two month long ‘Swasth Saarthi Abhiyan’ of IGL focusing on providing free preventive healthcare for nearly 5 lakh drivers of Delhi NCR is being inaugurated at a special event in Siri Fort Auditorium on Wednesday, 28th June 2017 along with a ‘Fuel Conservation Workshop’ being organized by PCRA as a part of Saksham 2017 – the mass Oil and Gas Conservation Campaign. Hon’ble Union Minister for Science Technology, Environment, Forests, Climate Change Earth Sciences,

Harsh Vardhan, Minister of State for Petroleum Natural Gas (Independent Charge), Dharmendra Pradhan, along with Hon’ble Members of Parliament from Delhi, would be launching the campaign. Wrestling legend, Babita Phogat would also be present on the occasion to lend her voice to the campaign. This was announced by  P.K. Pandey, Vice President (Marketing), IGL while addressing a Curtain Raiser on the event for the media.

The event is a unique initiative to address the major issues being faced by public transport drivers of the region, with almost all of them being users of CNG.

A mega Health Camp is being held on the occasion to provide basic preventive health care needs like Height-weight, BMI and Blood pressure measurement, Vision Eye checkup, Blood group testing, Counseling, Health Education First Aid tips. Free basic medicines and spectacles would be provided in cases, where required.

The campaign would continue in form of health camps at various CNG stations of IGL till 31st August 2017.

Each driver attending the event on 28th June at Siri Fort Auditorium would be provided a free coupon for getting CNG upto Rs 100/- filled at any CNG station of IGL. In addition, they would also be provided a first aid kit and LED torch.

The drivers becoming a part of Swasth Saarthi Campaign subsequently through health checkup camps at CNG stations of IGL till 31st August would be given free coupons worth Rs 50/- per driver for getting CNG.

A web application is also being launched on the occasion, which would enable the drivers who have undergone health checkup in the campaign to access their health records online from anywhere.

PCRA would be conducting a special workshop during the event, where message on fuel conservation and good driving habits would be disseminated to the gathered drivers. Such workshops have already been conducted across various cities as a part of Saksham 2017.

Delhi Police is supporting this event through its Road Safety Cell and Women Safety Cell. The messages of road safety, responsible behavior towards passengers, especially women and elderly would be disseminated through interesting skits and street plays at the event.

A host of cultural performances have also been lined up for the event with famous standup comedian Sunil Grover “Gutthi’ being highlight of the day. Musical performances with known singers and a dance troupe will continue till evening.

Public transport drivers form one of the biggest stakeholder groups of IGL with almost all of them being users of CNG and making almost daily trips to CNG stations. Welfare of this group finds a prominent place in the CSR programme of IGL.

Company Profile

The role of IGL in checking the vehicular pollution in the National Capital Region is well acknowledged both at national as well as international forums. IGL has well laid out its city gas distribution infrastructure in Delhi, Noida, Greater Noida and Ghaziabad which consists of over 10000 Kms of pipeline network. IGL is meeting fuel requirements of over 9.5 lakh vehicles running on CNG in NCR through a network of 425 CNG stations. IGL is supplying PNG to nearly 7.5 lakh households in Delhi and NCR towns.

Pcra and IGL to Launch a Campaign for Good Health, Behaviour and Fuel Conservation for Drivers added by Team EnergyInfraPost on June 26, 2017
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65 percent of Americans would rather have this than a lot of money

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18 Hours Ago


There’s more to wealth than net worth. In fact, a new survey from Charles Schwab finds that Americans lean towards definitions of wealth that money can’t buy.

When asked, “to me, having wealth means,” only 35 percent of the 1,000 Americans surveyed selected “having a lot of money.” The other 65 percent chose “having good physical health.”

While the majority of Americans would rather be in good shape than earn a large paycheck, those two things aren’t mutually exclusive. Research shows that exercising could actually help you when it comes to striking it rich. In a five year study of self-made millionaires, author Tom Corley found that the wealthy exercise consistently.

Richard Branson is an avid kite surfer

Plus, exercise, he claims, boosts his productivity significantly: “I definitely can achieve twice as much by keeping fit,” Branson tells FourHourBodyPress.

Zuckerberg also knocks out his workout right away. “I make sure I work out at least three times a week — usually first thing when I wake up,” says the Facebook founder in a QA. “Staying in shape is very important. Doing anything well requires energy, and you just have a lot more energy when you’re fit.”

Ultimately, if you make health and happiness a priority, says Branson, “the rest will follow.”

Don’t miss: How Mark Cuban, Richard Branson, and 34 other top execs stay in shape

Billionaire Richard Branson learned a key business lesson playing tennis

Kathleen Elkins

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