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Prevalence of and reasons for women’s, family members’, and health professionals’ preferences for cesarean section …

8,9,14,15,35–72]. Figs 2 and 3 show forest plots of the proportion of women preferring CS by when the preference was reported by the woman (i.e., early or middle pregnancy, late pregnancy, or postpartum) across longitudinal studies and cross-sectional studies, respectively.

*Retrospective design, in which women were asked to recall their preference for a mode of delivery in early or middle pregnancy and in late pregnancy. CS, cesarean section; IV, inverse variance.


https://doi.org/10.1371/journal.pmed.1002672.g002

CS, cesarean section; IV, inverse variance.


https://doi.org/10.1371/journal.pmed.1002672.g003

In the stratification of the study design, the pooled proportions of preference for CS reported by women in longitudinal studies were 14% in early or middle pregnancy (95% CI 12%–17%; χ2 = 20.42; df = 5 [p 0.01]; I2 = 76%) [9,14,15,35,68,69] and 21% in late pregnancy (95% CI 15%–26%; χ2 = 109.02; df = 6 [p 0.01]; I2 = 94%) [9,14,15,35,36,68,69]. In cross-sectional studies, the proportions were 17% in early or middle pregnancy (95% CI 14%–20%; χ2 = 36.61; df = 6 [p 0.01]; I2 = 84%) [8,37–41,72], 22% in late pregnancy (95% CI 18%–25%; χ2 = 697.67; df = 18 [p 0.01]; I2 = 97%) [42–50,56,57,62,63,65–67,70–72], and 30% postpartum for the index pregnancy (95% CI 19%–40%; χ2 = 809.43; df = 7 [p 0.01]; I2 = 99%) [51–53,55,58–60,71]. More multiparous women reported preference for CS (33%, 95% CI 31%–35%; χ2 = 114.78; df = 3 [p 0.01]; I2 = 97%) [56,66,67,72] than nulliparous women (13%, 95% CI 12%–14%; χ2 = 282.46; df = 15 [p 0.01]; I2 = 95%) [8,39–42,44–47,49,53,56,62,65,67,72]. Both univariate and multivariate meta-regressions showed significant association of the prevalence of preference for CS with parity (p 0.05), but there was no significant association with study design, time preference was reported, study region, location, level of study facilities, risk for the pregnancy as defined by the study authors, and quality of study as assessed by the review authors. These results are presented in S1 Data. Moreover, 18 of 42 studies (4 longitudinal and 14 cross-sectional studies) [9,14,15,43–49,54,56,57,60,63,64,69,72] revealed that some pregnant women, ranging from 3% to 34%, did not have a straightforward preference for a mode of delivery, even in late pregnancy (S5 Table).

Six longitudinal studies [9,14,15,35,68,69] investigated the change of preference from early or middle pregnancy to late pregnancy, whether prospectively or retrospectively. All 6 studies reported an increase in the preference for CS as birth time approached, and the mean difference to test the change was statistically significant (mean difference 7%, 95% CI 1%–13%; χ2 = 63.76; df = 5 [p 0.01]; I2 = 92%). One longitudinal study in mainland China investigated both women’s and their partners’ preferences for mode of delivery in late pregnancy and immediately postpartum if they could hypothetically choose again [36]. In this study, while only 10% of women reported a preference for CS in late pregnancy, this preference rose to 28% after giving birth. Likewise, the preference for CS among their partners also increased from 8% in late pregnancy to 17% in the immediate postpartum period.

73]. One study in eastern China investigated maternity care providers’ preference for mode of delivery if they or their partners were pregnant, and found that one-fifth of maternity care providers (94 of 462) preferred CS [74].

75–77]. In the longitudinal study, 90.2% of women preferred CS in early pregnancy, and the proportion of preference for CS showed moderate decrease in mid-term pregnancy (77.3%) and late pregnancy (71.1%) [75]. Two cross-sectional studies reported 48.7% and 44.6% of women preferring CS when they had prenatal visits for the current pregnancy [76,77].

Article source: https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002672

Held Hostage by Health Insurance

The next day, the offer came, with one change — no group insurance. Instead, I would receive $500 to buy my own policy. When I told him that could not work, he pressed me to explain. Reluctantly, I revealed my epilepsy. The next morning, on my first day of work, he told me that I was off salary and I was no longer allowed in the office. Less than 24 hours after I disclosed my epilepsy, the advocacy group decided I had to work as a freelancer from home. My chance for insurance evaporated.

Job after job followed, none with coverage. Months before my dreaded 25th birthday, I took a low-level editor’s post compiling career announcements for a Washington magazine; I hated the work, but I needed the health coverage. Weeks into the job, the insurer rejected a bill for my anticonvulsants; unknown to me until that moment, the magazine’s insurance policy included a pre-existing condition clause.

Desperate, I pleaded with colleagues for help. One journalist offered to assist me in gaining work as a copy boy at The New York Times — a job many rungs lower on the career ladder, but one that offered insurance. In my interview, a perplexed editor stared at my résumé. Why, he asked, would I trade an editor’s job for one fetching coffee?

I lied. I revealed nothing about my health issues or my fears of financial wreckage. Instead, I rhapsodized about The Times. I got the job.

I turned 25 before my Times policy went into effect, leaving me uninsured for a few weeks. During that gap, I found myself post-seizure in an emergency room. Realizing I was responsible for all the costs, I demanded to be released and staggered outside. I woke up hours later on the sidewalk. My parents paid the multi-thousand-dollar hospital bill out of pocket.

I worked seven days a week as a copy boy and then news clerk, terrified that easing up would cost me my job and my insurance. Thankfully, in 1988, The Times promoted me to reporter.

By 2005, I was married and considered going on my wife’s employer’s insurance plan so that I could become a full-time book writer. But my wife is four years older than me, and she hoped to retire at 65, when she aged into Medicare. If I was solely an author, at the age of 61 I would be both uninsured and uninsurable. I abandoned the idea.

Article source: https://www.nytimes.com/2018/10/15/opinion/affordable-care-act-pre-existing-conditions.html

Universal health care is more myth than reality. Medicare for all is a decent step toward it

Millions of Americans live with health care coverage that is either incredibly expensive or poor to nonexistent. It’s no surprise, then, that the push is on throughout the country for some form of universal health care, such as the Medicare for All plan promoted by Sen. Bernie Sanders (I-Vt.).

Is the idea of a universal health care system that’s paid for and run by the government and has only trivial out-of-pocket costs truly plausible?

I’ve been following health care for some 35 years. So just out of curiosity, I decided to look at European countries with universal health care. They’ve appeared to be the utopian goal for health care for many of us over the years, thinking “If we could only get there!”

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I was surprised to discover two unsettling realities. One of them is that there is no such thing as universal health care, if by that we mean full and free health care paid for by the government. The other is that the U.S. is in an odd position. Our government pays a larger per-capita percentage of our health care costs than any other country, yet we have out-of-pocket costs that aren’t greatly out of line with other countries.

Here is a brief summary of data compiled by the Commonwealth Fund of 13 mostly European high-income countries that tells the story. Health care spending as a percent of gross domestic product is highest in the U.S., at 17 percent. That is 50 percent higher than in runner-up France, at 11.6 percent. As in the U.S., all of the European systems have out-of-pocket costs. In this category, Switzerland topped the list, averaging at $1,630 per person per year, followed by the U.S at $1,074. The lowest out-of-pocket spending by far was the U.K., at $321 (see the table below).

When it comes to public financing of health care, the U.S. is the leader, with per-capita spending of $9,086. Yet despite that investment plus modest out-of-pocket spending, life expectancy in the U.S. is lower than it is in any European country.

It is also worth noting that one can easily find Europeans bemoaning the state of their health care systems. A 2017 report by the British House of Lords said that “Our NHS, our ‘national religion’ is in crisis and the adult social care system is on the brink of collapse.” Another analysis found that that, “Across the world, universal care is in bad shape.”

The greatest obstacle to a Medicare-for-all plan is that it would, not surprisingly, be prohibitively costly. Neither Sanders nor the Congressional Budget Office has calculated its costs. A recent estimate from the Mercatus Center projected that it would increase the federal budget by approximately $36.6 trillion in its first 10 years, although Sanders and others dispute the findings. Enthusiasm for a single-payer plan has been strong in California, but legislative progress in that direction has stalled because of its projected costs.

What I find most disturbing is the comparatively low U.S. life expectancy despite high government spending. The culprit is at least three-headed: inefficiency, high labor and technology costs, and political and other barriers to government control of drug costs and expensive technologies. There is hardly any guarantee that a Medicare for all plan could cut through all those obstacles, or even come close to doing so.

Sen. Elizabeth Warren (D-Mass.) has proposed an alternative plan. She judges that a single-payer plan would be difficult to get through Congress and concedes that private insurance will have to continue. But that insurance would “have to be at least as good and priced as reasonably as the coverage provided by our public health care programs.” The obvious advantage of her plan is that it aims to build upon and improve the embattled Affordable Care Act, likely making it easier to get through Congress than a single-payer plan. Warren’s plan would benefit from the strong gain in public support for the ACA over the past couple of years despite assaults on it by President Trump and other Republicans.

It would be foolish to think that it will be possible in the years ahead to devise an ideal or perfect health care system. The number of Americans age 65 or older, now at nearly 51 million, will rapidly continue to grow, as will medical and technological ways to keep them alive longer. A major consequence will be longer lives, with new drugs and expensive devices to keep people alive longer. Hardly less important, there will be a historic turning point by 2035: The number of those over 65 (78 million) is projected to exceed those under 18 (76.7 million).

Even with great public support for affordable universal care, European countries are stumbling and gasping. The U.S. is likely to do the same. Some improved form of universal care will help, but there is no magic elixir, here or there, to find a politically affordable program covering all health needs.


But progress is possible. Two congressional moves would make a great difference. One of them would be to rescind the 2003 law prohibiting the Department of Health and Human Services from negotiating drug prices on behalf of Medicare beneficiaries. The other would be to set an income-based limit on out-of-pocket health expenses, with government paying the difference.

While I believe that Trump’s view of Medicare for All, which he laid out in a recent op-ed for USA Today, is wrong, its very grandiosity opens the door to resistance. Nonetheless, there is a need for a stronger and more equitable health care system, and Warren’s plan so far is the most plausible.

Daniel Callahan is co-founder and president emeritus of The Hastings Center, an independent bioethics research institute based in Garrison, N.Y.

Article source: https://www.statnews.com/2018/10/16/medicare-for-all-health-care-elizabeth-warren/

Home Health Industry Can’t Fight CMS’ New Pre-Claim Review Initiative

To combat improper billing, the Centers for Medicare Medicaid Services (CMS) in 2016 rolled out the controversial pre-claim review demonstration in Illinois, an initiative that required home health providers to send in their claims earlier in the care process. With the help of Congress, however, stakeholders were able to seemingly stop pre-claim review dead in its tracks.

CMS unexpectedly revived the initiative with some tweaks this summer. But the industry likely won’t be able to defeat the new version of pre-claim review, policy experts warn.

“I don’t know how much we can fight this at this juncture,” Mary Carr, vice president of regulatory affairs for the National Association of Home Care Hospice (NAHC), said Oct. 9 while presenting at the organization’s annual leadership conference in Grapevine, Texas. “The chips will fall where they may.”

CMS’ new version of pre-claim review — now called the review choice demonstration — allows home health agencies to forgo prior claims authorization in favor of post-payment review. In post-payment review, providers would affirm claims after they had already received payment, giving CMS the opportunity to rescind funds if any issues are uncovered.

The proposal additionally allows home health providers to opt out of prior and post-payment review and instead take a 25% reduction on all payments for claims submitted. Providers that achieve a targeted claim approval rate can choose to opt out of claim reviews in favor of a spot check to ensure continued compliance.

The latest update with the new version of pre-claim review from CMS is that it — if implemented — will go into effect in Illinois on Dec. 10, 2018.

Stakeholders can currently comment on the initiative during a 30-day comment window that closes at the end of the month.

An April report from the Government Accountability Office (GAO) that highlighted savings from the 2016 initiative was a decisive blow to the industry’s battle against pre-claim review, according to Carr. Estimated savings from the original implementation through March 2017 could have been as high as $1.9 billion, the watchdog entity found.

“That GAO report was a killer,” Carr told Home Health Care News in an interview following her presentation. “It showed significant savings.”

While savings to the Medicare program is a positive outcome from CMS’ standpoint, the push to revive pre-claim review in its proposed form is misguided because it lacks insight gained during the original version, Carr said, adding that smaller agencies are the providers that suffer the most under the initiative.

“There’s got to be some sort of pattern that the data shows where you can target this a little more accurately than just doing this baby-out-with-the-bathwater type of approach,” she said. “We still see that a targeted approach is the appropriate way to go. From what we understand, [CMS] never even analyzed the data they got from pre-claim review.”

Viable alternatives to pre-claim review readily exist that are far less costly and  burdensome with potentially more effectiveness, Carr said, adding that NAHC still plans to push back on pre-claim, as it did in the past, despite the somewhat less-promising outlook.

One positive in the new iteration, according to Carr, is that providers in Illinois with a history of hitting affirmation targets of 90% would likely be able to skip post- or pre-claim review. In those cases, they would likely be able to immediately jump into the spot-check option, she said.

“If you proved, through the last pre-claim review, that you had this 90% affirmation rate, then you don’t necessarily have to go through 100% review,” Carr said. “You might be able to check in to one of these more random reviews or other options.”

After Illinois, the new pre-claim review version is planned for Texas, Ohio and North Carolina.

While the industry is largely against pre-claim review, improper payments are currently up, according to Carr.

CMS has maintained that its new version of pre-claim review would not add an unreasonable amount of administrative burden to home health agencies in targeted states.

More than two dozen members of Congress sent a letter to CMS Administrator Seema Verma in September calling for more clarification on — and voicing concern about — the revived pre-claim review initiative.

Written by Robert Holly

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Article source: https://homehealthcarenews.com/2018/10/home-health-industry-cant-fight-cms-new-pre-claim-review-initiative/

Houston health group to lobby against immigrant policy change in DC


  • Marcela Parra, left, a navigator at Epiphany Community Health Outreach Services (ECHOS) helps a customer fill up paperwork with a customer who does not wish to be identified, Monday, Oct. 1, 2018, in Houston. Photo: Marie D. De Jesús, Houston Chronicle / Staff Photographer / © 2018 Houston Chronicle

    Marcela Parra, left, a navigator at Epiphany Community Health Outreach Services (ECHOS) helps a customer fill up paperwork with a customer who does not wish to be identified, Monday, Oct. 1, 2018, in Houston.

    Marcela Parra, left, a navigator at Epiphany Community Health Outreach Services (ECHOS) helps a customer fill up paperwork with a customer who does not wish to be identified, Monday, Oct. 1, 2018, in Houston.


    Photo: Marie D. De Jesús, Houston Chronicle / Staff Photographer

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Marcela Parra, left, a navigator at Epiphany Community Health Outreach Services (ECHOS) helps a customer fill up paperwork with a customer who does not wish to be identified, Monday, Oct. 1, 2018, in Houston.

Marcela Parra, left, a navigator at Epiphany Community Health Outreach Services (ECHOS) helps a customer fill up paperwork with a customer who does not wish to be identified, Monday, Oct. 1, 2018, in Houston.



Photo: Marie D. De Jesús, Houston Chronicle / Staff Photographer


Legacy Community Health, the largest network of community health clinics in Texas, will send a group to Washington this week to lobby lawmakers against a new Trump administration rule change that could hold using health and nutrition assistance programs against immigrants seeking legal residency.

At issue is a proposed revision in the so-called public charge rule that would greatly expand the negative factors determining if an immigrant seeking a temporary visa or green card is now or will “likely” become a burden on taxpayers.


The Department of Homeland Security unveiled the expanded rules last month and a 60-day period for public comment began last week.

“Legacy is doing a full-court press on this one,” said Kevin Nix, a spokesman for Houston-based Legacy said on Monday.


RELATED: New rule: Tougher scrutiny on legal immigrants using assistance brings widespread fear

A delegation from the community health organization will meet Tuesday and Wednesday with 15 senior staff or Congress members across party lines to argue that the rule will not only do sweeping harm to legal immigrants but also financially hurt community health centers across the country, said Nix.

Nix said they will meet mostly with Texas lawmakers and staff but also other lawmakers who have supported community health centers. He did not name the lawmakers.

The delegation plans to make the case that if eligible patients do not enroll in health programs such as Medicaid and need-based Medicare prescription drug coverage, the impact will be felt far beyond immigrant communities, he said.

Uninsured rates will increase, as will the use of emergency rooms for routine treatments and the amount of uncompensated care borne by taxpayers could rise dramatically, Nix said.

The Department of Homeland Security has said it is expanding the public charge rule to encourage more self-sufficiency among immigrants seeking legal residency. The policy is in keeping with the Trump administration long-held goal to promote “merit-based” immigration among those with more means, higher education and marketable skills.

The public charge designation has for nearly two decades been mostly focused on discouraging legal status for those who rely on cash-based benefits for primary income, or those who need long-term health care at government expense. The new rule would add applications for one or more health nutrition or housing assistance programs during the past three years, including most forms of Medicaid, need-based Medicare Part D prescription drug benefits, Supplemental Nutrition Assistance Program, or SNAP, formerly known as food stamps, and Section 8 housing vouchers and assistance.


It will also take into account income, education, chronic health conditions and insurance status when determining if an immigrant is likely to become a public charge.

Some community health groups are already reporting a decline in enrollment even among current green card holders and other legal immigrants not touched by rule change out of fear and confusion.

Katy Caldwell, executive director of Legacy, has said the rule will economically hit Houston especially hard because of the city’s large immigrant population and the volume of medical institutions.

RELATED: These immigrants are legal. It’s unbelievable what that they are being penalized for this basic human need [Opinion]

“The mission of Legacy Community Health, like any safety-net provider, is to provide quality, affordable care to low-income patients, including many legal immigrants,” she wrote in a recent Houston Chronicle opinion piece, “Our goal is to provide preventive care to keep people out of the emergency room for non-emergencies, such as colds, or for treatment of chronic conditions. We’ve been doing this for decades in a fiscally responsible way and with bipartisan support. But this new rule would likely limit the amount of care we can provide, and it would be the same for many other Texas providers.”

Article source: https://www.chron.com/business/article/Houston-health-group-to-lobby-against-immigrant-13307794.php

NASCAR drivers bid unexpected early farewell to Kasey Kahne amid health issues

LINCOLN, Ala. — Kasey Kahne announced in August his plans to retire at the end of the 2018 Monster Energy NASCAR Cup Series, but his final season was cut short.

Struggling with health problems this season — particularly severe dehydration and trouble regulating his heart rate and body temperature while racing — Kahne announced Tuesday that he has not been medically cleared to finish the season.

“Out of the race car I am perfectly healthy, I feel great, and the doctors have determined that I have no underlying health problems,” the 38-year-old explained on Twitter.

“My body just can’t handle extended periods of time in the race car and we weren’t able to control the sweat ratio to keep me hydrated enough to prevent any permanent damage to my body.”

After 17 years in NASCAR — 15 of which were in the Cup Series — Kahne’s stock car racing career is officially over, and his peers are devastated for him.

“It’s unfortunate that he is not able to come back,” Chase Elliott said at Talladega Superspeedway on Saturday. They were teammates in the 2016 and 2017 seasons at Hendrick Motorsports, where Kahne raced for six years before moving to Leavine Family Racing in 2018.

“I hate that he couldn’t do it on his own terms and decide that for himself.”

ELLIOTT: Likely the only driver who isn’t sweating Talladega

PREVIEW: Playoff drivers face daunting challenge at volatile Talladega

KAHNE ON RETIREMENT: I’ve ‘had enough at this point’

Although Kahne experienced some issues with dehydration and spiked heart rate in 2017, he explained in September that it’s been much more consistent this season.

His problems intensified at the Bojangles’ Southern 500 at Darlington Speedway. Kahne said he was so dehydrated he could barely keep his eyes open during the race and was physically sick afterward. He initially missed the following race — the regular season finale at Indianapolis Motor Speedway where he was the defending race winner — because he was still recovering from the severe heat exhaustion. But he has not raced in the No. 95 Chevrolet since Darlington.

After learning Kahne was done for the season, his former teammate, Dale Earnhardt Jr. applauded him on for making “a smart decision based on his doctors advice”.

In 15 Cup Series seasons, Kahne accumulated 18 wins in 529 starts. His last victory was the Brickyard 400 at Indianapolis Motor Speedway in 2017, and he also won NASCAR’s longest race, the Coca-Cola 600 at Charlotte Motor Speedway, three times (2006, 2008, 2012).

Darrell “Bubba” Wallace Jr. echoed the bittersweet reactions and said he texted Kahne after he heard the news.

“I told him I was praying for his future and hopefully everything gets a lot better,” Wallace said Friday at Talladega Superspeedway. “Kudos to him for sticking up for his health and not being selfish. I would be selfish about it and be wanting to drive.”

But Kahne is only done racing in NASCAR.

He still plans to compete in sprint car races — where he’s also a team owner — and his health isn’t a concern because the events are shorter and the cockpits are open.

“I was just working out with him (Thursday) some, and I know he really wanted to finish out the year and try and get a good, solid run to the end for his retirement,” Ricky Stenhouse Jr. said Friday. “I think he’s gonna be pretty happy running sprint cars.”


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  • Kasey Kahne, born April 10, 1980 in Enumclaw, Wash., began his NASCAR Sprint Cup career in 2004, going on to win rookie of the year.1 of 19
  • Kasey Kahne celebrates after winning the 2017 Brickyard2 of 19
  • Kasey Kahne (center with towel) and team owner Rick3 of 19
  • Kasey Kahne posted two top-five finishes in the 20164 of 19
  • Kasey Kahne would finish fourth in the Hollywood Casino5 of 19
  • Kasey Kahne (5) during practice for the Bank of America6 of 19
  • Kasey Kahne celebrates winning the Oral-B USA 500 at7 of 19
  • Kasey Kahne does a burnout after winning the GoBowling.com 400 at Pocono Raceway on Aug 4, 2013. Kahne also won at Bristol Motor Speedway in March.8 of 19
  • Kasey Kahne won twice in 2012: the Coca-Cola 600 at Charlotte and the 2012 Lenox Industrial Tools 301 at New Hampshire.9 of 19
  • Kasey Kahne watches the Sprint Cup race at Martinsville Speedway from teammate Jeff Gordon's pit box after blowing an engine early in the April 2012 race. Kahne replaced Mark Martin at Hendrick Motorsports at the beginning of 2012.10 of 19
  • Kasey Kahne earned his lone win of 2011 in the second-to-last race of the season at Phoenix  International Raceway in November.11 of 19
  • Kasey Kahne talks with crew chief Kenny Francis prior to the 2011 Daytona 500. Francis has been Kahne's crew chief since the end of the 2005 season.12 of 19
  • Kasey Kahne spotlighted the 2010 Team USA Vancouver Winter Olympic team on his uniform and car during Speedweeks at Daytona International Raceway in February of 2010.13 of 19
  • Kasey Kahne, left, hangs out with actors Bradley Cooper, center, and Jessica Biel in his team hauler prior to the 2010 Coca-Cola 600 at Charlotte Motor Speedway.14 of 19
  • Kasey Kahne, right, took owner Richard Petty to victory lane for the first time in 364 races in June 2009 at Sonoma. Kahne became a part of Richard Petty Motorsports at the beginning of 2009 after a merger with his previous team Gillett Evernham Motorsports.15 of 19
  • Kasey Kahne raises a Bud to the light to check its coloring during a beer tasting at Richard Petty Motorsports in April 2009. Budwieser sponsored Kane from 2008 through 2010.16 of 19
  • Kasey Kahne celebrates after winning the 2008 Coca-Cola 600 at Charlotte Motor Speedway. Kahne has more wins at Charlotte -- four -- than any other track.17 of 19
  • Kasey Kahne began his NASCAR career racing for former crew chief turned owner Ray Evernham. Here the pair celebrate Kahne's win at Texas Motor Speedway in April 2006.18 of 19
  • Kasey Kahne celebrates his first ever NASCAR Cup win at Richmond International Raceway on May 14, 2005.19 of 19

 

Article source: https://www.usatoday.com/story/sports/nascar/2018/10/14/kasey-kahne-health-problems-early-retirement-cup-series/1635945002/

Why Ben Affleck’s Shauna Sexton fling was bad for his health — and his image

Given how publicity shy Ben ­Affleck can be, 22-year-old Playboy model Shauna Sexton seemed like an odd choice for a girlfriend.

In late August, after Affleck was admitted to alcohol rehab for a third time, Sexton was seen prancing around Los Angeles in a tank top and tiny shorts, clutching a tabloid with the actor’s face on it and smiling for the paparazzi.

Last week, when the 46-year-old actor whisked her to his home in Big Sky, Mt. — a place where Affleck goes to escape the spotlight — Sexton took the opportunity to post photos of her troubled beau on Instagram.

Days later, when friends of Affleck told the media the brief relationship was over, Sexton adamantly denied the claims, telling a Web site: “‘Don’t believe everything you read on the Internet!”

Sources say the only thing that’s unbelievable is that Affleck would date the model to begin with.

“I think it’s so belittling,” said a Hollywood source who knows ­Affleck. “He found a girl who he can just go out drinking with and [have sex with].”

Sexton has been arrested for underage drinking and public intoxication, and has bragged on social media about her love of drinking and party­ing.

“At the end of the day, in order to be in recovery, [Affleck] needs to be by himself and taking care of his family,” the Hollywood source said. “He’s being used by this girl. Anyone who drinks the way she drinks and is out there publicizing it and their relationship, has no respect for him or his family.”

Ben Affleck, Jennifer Garner and friend
Ben Affleck, Jennifer Garner and friend on their way to bring Affleck to rehabSplash News

Affleck’s life has been anything but camera-ready recently. Before entering rehab the latest time, he was seen looking bloated and sweaty in the back seat of estranged wife Jennifer Garner’s Range Rover, eating Jack in the Box on his way to the treatment facility. Garner, 46, had staged an intervention for Affleck, who has battled alcohol addiction for almost two decades. Last week, after his 40-day rehab stint, the duo, who share three children, moved their ­divorce case to a private judge in order to speedily finalize it.

The couple filed for divorce in 2015 after rumors of Affleck cheating on Garner with their children’s nanny, Christine Ouzounian, and with “Saturday Night Live” producer Lindsay Shookus. (In a 2016 interview with Vanity Fair, Garner said: “We had been separated for months before I ever heard about the nanny. She had nothing to with our decision to divorce.”)

Garner allegedly confronted Shookus when she found text messages between the producer and Affleck in 2013, but Shookus “refused to stop” the dalliance, an ­insider told The Post in 2017.

Shookus and Affleck continued to date long-distance until August, when they broke things off, reportedly due to Affleck’s drinking problems — and his wandering eye. “He was cheating on Lindsay while he was in rehab with an employee there,” said the Hollywood source of Affleck’s March 2017 treatment.

(The actor’s rep did not respond to requests for comment.)

Tinseltown execs are taking note of Affleck’s instability.

In August, representatives for an insurance company told The Wrap that Affleck could potentially lose his lucrative Batman role because of the increased cost of insuring the volatile star.

Now, even attention-loving Sexton is realizing there are pitfalls to sticking with the leading man.

Shauna Sexton
Shauna SextonClint Brewer / SplashNews.com

Her friend, photographer Martin Murillo, who’s been helping Sexton land a modeling agent, told The Post that all the publicity surrounding her romance is actually working to her disadvantage.

“Now that this whole thing has happened, it’s gotten harder,” said Murillo, who photographs the voluptuous brunette twice a month for her social-media accounts.

“If I’m talking to an agent from LA Models, the first thing they [note] is that she’s dating Ben ­Affleck,” he added. “It could be a good thing, but I think they see it as, ‘Oh, here’s just another model wanting attention.’ ”

Murillo also claims Sexton, a Virginia Beach, Va., native, was forced to leave her day job as a technician at Veterinary Specialty and Emergency Center of Thousand Oaks, Calif., due to overwhelming paparazzi attention.

“I know it was affecting the people at her work so she decided to leave,” he said, adding that Sexton’s salary now comes from various Playmate events.

Days after Affleck went into treatment, Sexton posted a photo of herself at a restaurant, holding a glass of wine, leading Affleck fans to accuse Sexton of steering the “Argo” director down a bad path.

But Sexton defended herself on Instagram, copping to past mistakes and admitting she loves “to drink and party! Absolutely dude.”

“Do these mistakes mean I would disrespect someone’s hard earned sobriety by drinking with them or in front of them? Hell no,” she wrote.

“With that being said, Ben is a grown ass man, baby. He makes his own decisions. Blaming a 22-year-old for someone’s 3rd time in rehab is just ridiculous . . . We all are going to f–k up, it’s just a matter of learning from it.”

According to Entertainment Tonight, Garner and Affleck’s sober counselors urged him to cut ties with Sexton.

“He has a lot of money and right now he’s still young enough that he needs to get his s–t together,” said the Hollywood source.

Otherwise, “one day he will drink too much and something bad will happen.”

Article source: https://pagesix.com/2018/10/13/why-ben-afflecks-shauna-sexton-fling-was-bad-for-his-health-and-his-image/

Health care budget woes await Minnesota’s next governor


  • FILE - In this Aug. 17, 2018 file photo, candidates for Minnesota governor, Democrat Tim Walz and Republican Jeff Johnson shake hands at the beginning of their first debate at Grand View Lodge, Nisswa, Minn. Amid big health care campaign promises, Minnesota's next governor will be tasked with fixing a math problem: How can the state continue covering its existing programs. Walz and Johnson will weigh the fate of a provider tax that helps cover more than 1 million Minnesotans but is set to expire. (Glen Stubbe /Star Tribune via AP File) Photo: Glen Stubbe, AP / Star Tribune

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ST. PAUL, Minn. (AP) — While Democrat Tim Walz pushes for a public health care option and Republican Jeff Johnson aims to pare back parts of the Affordable Care Act, Minnesota’s next governor will face a basic math question next year: How will the state keep paying for its programs?

On the first year of the job, Walz or Johnson and a new Legislature will consider the fate of a 2 percent tax on medical providers that expires at the end of the year. It contributes hundreds of millions of dollars toward two health care programs that cover nearly 1.5 million poor Minnesotans.


They’ll also weigh renewing a $549 million program that stabilized insurance premiums after years of double-digit increases for residents who buy their own coverage. A top state regulator is calling for action in the first few months of 2019. Failure to do so could cause another round of rate spikes.


Combined with previous budgetary maneuvers agreed by outgoing Democratic Gov. Mark Dayton and Republicans, more than $2 billion in a new state budget and health care for millions of Minnesotans is up in the air. The answer will start with voters, who in November will choose a new governor, all 134 House members and a single state Senate seat that will determine control of that chamber.

“We have huge challenges, regardless of who wins the election,” said Democratic state Sen. Tony Lourey. “People’s lives hang in the balance of this conversation. That’s not an overstatement.”

Health care debates are front and center in Minnesota and nationwide, as Democrats fight to regain control of the House and Senate in the midterm election. It’s a similar script in Minnesota’s open race for governor. Walz is a fifth-term Democratic congressman from southern Minnesota running against Johnson, a Hennepin County commissioner who lost to Dayton in 2014.

Johnson is campaigning to remove some regulations in Minnesota’s health care market that he says should increase competition and lower prices. That includes dismantling MNsure, allowing insurers to sell policies across state lines and eliminating some of the conditions insurance plans must cover. Johnson said he couldn’t list which conditions could be chopped.

The Republican has blasted Walz’s plan to offer a public buy-in for MinnesotaCare — the state’s subsidized program for the working poor — as unworkable and unaffordable. He says it would imperil hospitals and clinics because MinnesotaCare reimburses them for health care at a lower rate than standard insurance.


Walz acknowledged those reimbursement rates have long been challenging. But he dismissed Johnson’s plan as relying on the private insurance market to lower costs.

“Pretending that the market’s going to make all that happen, that’s simply fantasy,” he said. “If you’re running for governor and your plan is to scream single payer at me, you ain’t getting anything done.”

But big campaign promises could be crowded out by the need to simply ensure that existing services are funded.

Dayton agreed to end the provider tax in 2011, a linchpin to reaching a budget deal with legislative Republicans that year and ending the state’s longest government shutdown. The 2 percent tax, which provides more than $500 million each year for MinnesotaCare and other subsidized health care programs like Medical Assistance, is to expire at the start of 2020.

That would leave a daunting hole in the state’s budget, exacerbated in 2017 when Dayton and Republicans agreed to use those tax revenues to temporarily cover a large slice of Medical Assistance funding. Lawmakers will have to fill both gaps in 2019, raising the prospect of both renewing the tax and program cuts.

Walz said he’d push to reinstate the tax, which Johnson and Republicans have derided it as a “sick tax.” Johnson said he’s committed to protecting MinnesotaCare but would sub in general tax dollars instead.

Extending Minnesota’s reinsurance program to tamp down health care premiums could be an easier sell — premiums are poised to drop as much as 28 percent in 2019, and the state is projected to have money left over from the $549 million lawmakers appropriated in 2017 to carry over for a renewal. Department of Commerce Commissioner Jessica Looman said the Legislature should approve a plan in the first few months of 2019.

Republicans up and down the ballot in Minnesota have trumpeted the program’s success and faulted Democrats for dragging their feet. Many Democrats voted against the bill in 2017, and Dayton let it become law without his signature.

Walz and Johnson said they’d support it, but both candidates said they’d rather push for larger measures to bring costs down rather than subsidize insurers to cover big health care bills.

“If we don’t have something in place in the first year that I feel is going to have an impact, we may have to do that,” Johnson said. “We might not have any other choice, otherwise we’re going to see the individual market explode again.”



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Article source: https://www.sfgate.com/news/article/Health-care-budget-woes-await-Minnesota-s-next-13306080.php

Bernie Sanders: Trump lies about ‘Medicare for All’ and he’s made health care worse

The American people have a very clear choice in the upcoming elections. On one side is Donald Trump and the Republican leadership in Congress, who made throwing 32 million Americans off of health insurance their number one priority in Washington. On the other side is my “Medicare for All” plan supported by 16 senators and 122 House members. It would guarantee everyone could get the health care they need without going into debt at far lower cost than the current dysfunctional system.

And Americans are very clear about which side they are on. In a poll last summer, 70 percent said they support expanding and improving Medicare to cover everyone in our country. They understand that there is something profoundly wrong when our current dysfunctional health care system is designed not to provide quality care to all, but to enable the private health insurance industry and drug companies to make billions in profits.

Despite spending almost twice as much per capita as any other country, 30 million Americans have no health insurance and many more are underinsured with high deductibles and co-payments. Further, the pharmaceutical industry charges us, by far, the highest prices in the world for prescription drugs. It is insane that today it costs an average of $28,000 a year to provide health insurance to a family of four. It is equally insane that one out of five Americans cannot afford the prescription drugs their doctors prescribe.

Donald Trump has only made health care worse

Medicare is the most popularsuccessful and cost-effective health insurance program in the country. Today, only people 65 and older are eligible for it. Americans shouldn’t have to wait that long to get the high-quality health care they need and deserve.

As president, Trump has made our health care system worse. While we were able to defeat his budget which proposed a $1 trillion cut to Medicaid, a $500 billion cut to Medicare and a $72 billion cut to the Social Security disability fund, we were unable to stop other very harmful measures.

As a result of his efforts to sabotage the Affordable Care Act, 13 million more Americans will become uninsured over the next decade while millions more have seen their premiums rise. Further, his administration is working alongside 20 Republican state attorneys general to end the protection that the Affordable Care Act now guarantees to people with pre-existing conditions, such as cancer, heart disease and diabetes. No one can estimate how many thousands of those people will die if they can no longer purchase affordable insurance.

More: Trump: Democrats’ ‘Medicare for All’ plan will demolish promises to seniors

Medicaid expansion is popular. Democrats should build on it in midterms and beyond.

Donald Trump erodes Social Security and Medicare solvency while blaming Democrats

We have a different idea: Expand Medicare to all. My bill would provide comprehensive and cost-effective health care for everyone — without out-of-pocket expenses.

Study after study shows that when we eliminate private insurance premiums, deductibles and co-payments, the average American will pay substantially less for health care than he or she currently pays. For example, a recent study by RAND found that moving to a Medicare for All system in New York would save a family with an income of $185,000 or less about $3,000 per person a year, on average.  Even the projections from the conservative Mercatus Center suggest that the average American could save about $6,000 under Medicare for All over a 10-year period.

Medicare for All not only benefits individuals and families, it would also benefit the business community. Small and medium sized businesses would be free to focus on their core business goals instead of wasting precious energy and resources navigating an incredibly complex system to provide employee health insurance. Equally important, with universal health care, workers would not have to stay at jobs they dislike just because their employer provides decent health insurance. 

Medicare for All is better for seniors

Given the president’s propensity to lie about almost everything, it is not surprising that Trump is grossly distorting what the Medicare for All legislation does. 

Our proposal would not cut benefits for seniors on Medicare, as the president and his Republican allies claim. In fact, we expand benefits. Millions of seniors today cannot afford dental care, vision care or hearing aids because Medicare does not cover them. Our proposal does. In addition, Medicare for All would eliminate deductibles and copays for seniors and significantly lower the cost of prescription drugs. Medicare for All allows seniors and all Americans to see the doctors they want, not the doctors in their insurance networks.

Trump claims that Medicare for All is not affordable. That is nonsense. What we cannot afford is to continue spending almost twice as much per capita on health care as any other country on Earth. We can’t afford the $28,000 it currently costs to provide health insurance for the average family of four.  We can’t afford to have 30 million Americans with no health insurance and even more who are under-insured with high deductibles and high co-payments. We can’t afford to have millions of Americans get sicker than they should, and in some cases die, because they can’t afford to go to the doctor.

Here is the bottom line: If every major country on earth can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States of America cannot do the same.

Bernie Sanders is an independent senator from Vermont. Follow him on Twitter: @SenSanders

 

Article source: https://www.usatoday.com/story/opinion/2018/10/11/bernie-sanders-donald-trump-lies-medicare-all-health-care-column/1594863002/

Health officials confirm brain-eating amoeba at BSR despite owner giving ‘all clear’

WACO,Texas — Naegleia Fowleri, the brain-eating amoeba that killed a New Jersey surfer, was identified at BSR Cable Park, according to the Waco-McLennan County Health District.

The district released the findings Friday. The release said in part, “Results of environmental sampling conducted by the Centers for Disease Control and Prevention (CDC) in collaboration with the Waco-McLennan County Public Health District (WMCPHD) and the Texas Department of State Health Services (DSHS) found evidence of Naegleria fowleri, a free-living ameba (single-celled organism) that causes Primary Amebic Meningoencephalitis, a rare and devastating brain infection with an over 97% fatality rate at the BSR Cable Park and Surf Resort (BSR). A New Jersey resident who had visited BSR this summer died after contracting the disease. Epidemiologic and environmental assessment indicates that exposure likely occurred at this facility.”

The release also said that while the amoeba was found in the park, it was not specifically found “in the Surf Resort, Lazy River, or the Royal Flush on the day of sampling.”

RELATED:

‘Brain-eating amoeba’ death closes BSR Surf Resort in Waco

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Kelly Craine with McLennan County Public Health District told KCEN Channel 6 on Friday that the surf park, the lazy river, and the royal flush slide had conditions that were favorable to the growth of the amoeba.

Craine said there was no chlorine to disinfect the water and the water had a high turbidity, which means it was cloudy. She also said there were fecal matter bacteria in the water, which also contributes to an environment ideal for brain-eating ameoba.

The Waco-McLennan County Health District said that the Surf Resort, Lazy River, and the Royal Flush are closed and will not reopen without consultation with the health district and a proper treatment.

The full release from the Waco-McLennan County Health District is below:

“Results of environmental sampling conducted by the Centers for Disease Control and Prevention (CDC) in collaboration with the Waco-McLennan County Public Health District (WMCPHD) and the Texas Department of State Health Services (DSHS) found evidence of Naegleria fowleri, a free-living ameba (single celled organism) that causes Primary Amebic Meningoencephalitis, a rare and devastating brain infection with an over 97% fatality rate at the BSR Cable Park and Surf Resort (BSR). A New Jersey resident who had visited BSR this summer died after contracting the disease. Epidemiologic and environmental assessment indicate that exposure likely occurred at this facility.

“N.fowleri was identified in the Cable Park but not specifically found in the Surf Resort, Lazy River, or the Royal Flush on the day of sampling. Although the N. fowleri was not detected in the Surf Resort, Lazy River, or the Royal Flush, the presence of fecal indicator organisms, high turbidity, low free chlorine levels, and other ameba that occur along with N. fowleri indicate conditions favorable for N. fowleri growth. For additional information, refer to the attached Environmental Microbiology Laboratory report.

“The BSR water venues known as the Surf Resort, Lazy River, and the Royal Flush are currently closed and will not re-open without consultation with the WMCPHD and not before all health and safety issues have been addressed and mitigated appropriately. The Cable Park may remain open to the general public because the risk of exposure to N. fowleri is considered the same as any other natural bodies of freshwater and is not amenable to treatment. WMCPHD is working with the owner who is consulting with water treatment experts to evaluate the situation and develop a comprehensive water quality management plan to include current regulatory requirements.

“The mission of the Waco-McLennan County Public Health District is to protect public health and safety. We appreciate the cooperation and assistance from the CDC and DSHS and will continue working diligently to address the issues raised by the report.”

The lab results provided the health district are as follows:

Health District Amoeba Report – 10-12-18 by Paris on Scribd

Prior to the release of the health district’s report, BSR Cable Park owner, Stuart Parsons, released a statement Friday that said the water test results at the park came back clean of the brain-eating amoeba Naegleria Fowleri.

The park closed its wave pool September 30 after Fabrizio ‘Fab’ Stabile visited the park and died from the deadly bacteria.

Parsons also announced that a state of the art water filtration system would be installed for the surf pool, Lazy river and at the Royal Flush slide.

According to the BSR press release, a North Carolina firm will work with local and state officials and the Centers for Disease Control to install the filtration system which will take until February.

“I built this water destination resort so people of all ages could learn to surf and wakeboard — and then go home safely to their families,” said Parsons.

“We take pride in our park and the safety of every guest. And to be clear, it’s not just the guests that use the park. It’s also my family, our friends, and our employees that essentially live in our water. My 2-year-old twins play on that beach, and — as kids do — they drink the water every time. So, you better believe my cousin, who tests and treats the water every day, is damn sure no one gets sick.”

Parsons also offered condolences to Stabile’s family and friends.

“A precious life has been lost, and we are deeply saddened for his loved ones,” said Parsons.

Parson’s full release is below:

“BSR SURF RESORT, Lazy River Royal Flush slide WATER TESTS COME BACK CLEAN

Installation of State of-the-Art Filtration System Already Underway; BSR Determined to Go the Extra Mile, Set Highest Standards for Safety First and foremost, on behalf of the entire staff at BSR Surf Resort, our hearts and prayers are with Fab Stabile’s family, friends, and the New Jersey surf community. A precious life has been lost, and we are deeply saddened for his loved ones.

“For the past two weeks, increased awareness of this incredibly rare disease, Naegleria fowleri, has swept the globe. What will come of all this news coverage and commentary? At BSR Surf Park, we are determined it will help save lives.

“Although comprehensive test results have now confirmed that the water at BSR Surf Resort meets every standard for safety, today I am announcing that we are going the extra mile and hiring a North Carolina firm to install a state-of-the-art filtration system to make our water in the surf, on lazy river, and at the Royal Flush slide is as clear and clean as humanly possible. It will take us to February to complete the installation of this new filtration system working very closely with local, state and CDC officials.

“There are only a few of these man-made surf parks in the country today, but many more will be built. Our goal is to set the highest standard for these facilities. Going forward, BSR Surf Resort will have the cleanest water anywhere in the United States.

“I built this water destination resort so people of all ages could learn to surf and wakeboard — and then go home safely to their families. We take pride in our park and the safety of every guest. And to be clear, it’s not just the guests that use the park. It’s also my family, our friends, and our employees that essentially live in our water. My two-year-old twins play on that beach, and — as kids do — they drink the water every time.

“So you better believe my cousin, who tests and treats the water every day, is damn sure no one gets sick.

“BSR wants to thank everyone that has supported us from the start, and believed in what we are trying to do. We want to make people happy — and safe — and that’s what we are going to continue to do.

We will update you on our progress through social media and our webpage, and look forward to seeing everyone soon with clear, blue, clean water.”

The fatality rate for Naegleria Fowleri is more than 97 percent, according to the CDC. Only four out of 143 known infected individuals in the United States from 1962 to 2017 survived, the CDC said.

Article source: https://www.kcentv.com/article/news/local/tests-show-brain-eating-amoeba-that-killed-surfer-not-from-bsr-cable-park/500-603831389