Health & Fitness (206)
CONCORD, N.H. (AP) -- Families shopping for health insurance through the new federal marketplace are running into trouble getting everyone covered when children are eligible for Medicaid but their parents are not.
Children who qualify for Medicaid, the safety-net program for the poor and disabled, can't be included on subsidized family plans purchased through the federal marketplace, a fact that is taking many parents by surprise and leaving some kids stuck without coverage.
A California man says he was given false assurances that his children could be covered by the same plan he picked for his wife and himself, and a Florida father says his daughter is going without coverage while he waits for answers.
And in New Hampshire, some parents who've enrolled in private plans for themselves alone are finding out later that their children aren't eligible for Medicaid after all, leaving their kids with no options.
"The children are getting stuck in this spot where we've enrolled the parent, but we can't bring the children back on the family plan," Maria Proulx, senior legal counsel for Anthem Blue Cross and Blue Shield of New Hampshire, told a state advisory board panel this month.
The federal Centers for Medicare and Medicaid Services declined to say how the system is supposed to work for families and what problems have emerged. But a regional manager for CMS acknowledged the problem at the same New Hampshire meeting and said the agency is working on it, as did Proulx in a later interview.
"This is an important issue, and we're not taking it lightly," she said. "Even if this impacts only one family ... it's a big deal and we want to get it resolved as quickly as possible."
The federal government sets minimum guidelines for Medicaid eligibility, but states can choose to expand coverage beyond that. In some states, parents must have significantly lower incomes to gain Medicaid coverage for themselves than they would to get coverage for just their children, either through Medicaid or the Children's Health Insurance Program - also known as CHIP - the low-income health insurance program for children who don't qualify for Medicaid.
In North Port, Fla., Russell Clouden was thrilled to find a better, cheaper family plan through the new marketplace, then stunned to realize his 14-year-old daughter wouldn't be enrolled because she might qualify for Florida Healthy Kids, the state's version of CHIP. The federal government still hasn't transferred roughly 90,000 Medicaid files over to Florida officials, including Clouden's daughter's, so she still doesn't have insurance.
"Based on your income, they'll separate your kids from your primary policy and they shift them off to Medicaid or Healthy Kids and there's no way you can bring them back," said Clouden, whose daughter is an accomplished equestrian jumper.
"I'm kind of in limbo with her because I'm just hoping she doesn't get injured or sick," said Clouden, 53, who runs a restaurant franchise. "Without insurance, you've kind of got a knot in your stomach watching her jumping."
Insurance broker Matthew Dinkel in Fort Myers, Fla., said he has about 15 clients in Clouden's position.
"I have worried parents literally calling and texting me every day asking for an update," said Dinkel. "They canceled their old plans that covered their entire family and now they have coverage but their kids don't."
Jessica Waltman of the National Association of Health Underwriters said her group has raised the problem, and others, with federal officials and asked for a dedicated hotline or email address for insurance brokers to get answers.
"It's a nationwide issue that we've heard time and again, and it could have very significant coverage issues for families," she said.
Marc Jobin, a construction consultant in southern New Hampshire, said the process has been so confusing, he's put off a decision for himself, his wife and their two children, even though he's seen premiums that are significantly lower than what they pay now.
"We've been hesitating for two months now because the information is not clear," he said. "Around the holidays, we were thinking, `let's do this, let's sign up,' and then the latest problem is now our children will probably be thrown into the state health care system, but nobody knows what that means."
Mary Ann Cooney, associate commissioner of the New Hampshire Department of Health and Human Services, urged those awaiting Medicaid decisions to call their state offices directly. She said her office has been getting incomplete application information from the federal government, making it harder to contact people to determine their Medicaid eligibility, but situations are improving and the office is reaching out to hundreds of people each day.
"There's a real light at the end of the tunnel," she said.
But in the meantime, children are going without coverage. In California, Robert Clark said when he applied by phone through the Covered California marketplace, he was assured that his two children would be on the plan he picked. But he later got separate notices from the insurance company and Medi-Cal, the state's Medicaid program.
He called Covered California again and was told the person he'd previously talked to there was wrong and that his children had to be enrolled in Medi-Cal. Clark, the president of a Menlo Park technology company, doesn't like that prospect because the doctors his children have seen since their births don't take Medicaid.
"It's pretty frustrating," he said. "We've probably spent several days' worth of time on hold."
Instead, he's exploring whether he can enroll his children in individual, unsubsidized plans through Covered California. He recently found out his original application was "hung up," so he plans to resubmit a fresh application, but in the meantime has lost out on coverage for January.
"My daughter is in gymnastics," he said. "If she falls on her head, we need to be covered."
Associated Press Writer Kelli Kennedy in Fort Lauderdale, Fla., contributed to this report.
A spate of bird flu cases since the beginning of the year in China has experts watching closely as millions of people and poultry are on the move ahead of the Lunar New Year holiday, the world's largest annual human migration.
China has reported more than 50 H7N9 infections in 2014 after the strain jumped from birds to people for the first time last year. The virus remains hard to catch and most cases have been linked to contact with poultry, but scientists worry that could change if it mutates into a form that allows it to spread easily among people.
For those who track influenza, the holiday, which begins Jan. 31, is always worrying because it comes during the winter months when flu typically rages. Add that to hundreds of millions of people - and often birds - crammed together on buses and other forms of transportation going home, and it's always a bit of a gamble. China estimates 3.6 billion trips will be taken over the holiday season.
"This is the first winter we've seen H7N9. We are in uncharted territory," said Gregory Hartl, World Health Organization spokesman in Geneva. "We have seen an upstart in cases, which we are attributing basically to the fact that it's winter. That combined with a lot of movement of people in crowded trains with chickens could give rise to a lot more infections, but we've also seen in past years where it hasn't."
The first H7N9 cases were reported in late March near Shanghai, and more than 200 others have since been identified, including some 50 deaths. A 31-year-old doctor became one of the latest fatalities, raising fears he may have been infected at the hospital where he worked, but none of his patients or other close contacts have reported flu symptoms, according to the Shanghai Municipal Commission of Health and Family Planning.
There have been a handful of family clusters, but WHO says no sustained human-to-human transmission has occurred. However, scientists warn that the H7N9 virus contains genetic markers that could help it infect mammals easier than other avian flus. Infected birds also do not show symptoms, making it harder to track the disease. Cases declined in China over the summer, which is typically slower for influenza viruses, after some local live poultry markets were temporarily closed.
In Hong Kong, which has logged three cases, officials will test all poultry for the virus beginning later this week. Taiwan has reported two cases.
In past years, it was the H5N1 bird flu virus that spiked during this time of year. That strain, which has killed at least 386 people since 2003, is still circulating widely in poultry stocks and kills about 60 percent of the people it infects.
On Tuesday, Vietnam, which has long battled the virus, confirmed its first H5N1 death in nine months. Earlier in January, the first human case was reported in North America after a person traveling back from a trip to Beijing became ill and died in Canada.
Both bird flus cause high fever and respiratory problems, including pneumonia and shortness of breath. Scientists have repeatedly warned that the viruses cannot be ignored because of their potential to possibly spark a global pandemic. But after years of campaigning in countries where it's common for chickens and pigs to live closely with people, sometimes in the same house, that message is often a hard sell.
"After almost a decade of sitting on the proverbial edge of the H5N1 pandemic cliff and not falling off, people are beginning to think that we never will fall," Michael Osterholm, an infectious disease expert at the University of Minnesota, said by email. "But the best scientific assessment of microbial genetics tells us we could still fall off of that cliff and if we do, the global consequences could be devastating."
Poultry is a central part of many families' dinner tables during the Lunar New Year festivities, and it's often bought live and killed at home in China and elsewhere across the region. The WHO urges care when slaughtering and preparing birds, including frequent hand washing. However, well-cooked meat and eggs do not pose a threat.
AP Medical Writer Margie Mason covers health issues across the Asia-Pacific. Follow her on Twitter: twitter.com/MargieMasonAP
ISLAMABAD (AP) -- In Pakistan, a country where breast cancer kills more women than terrorist attacks, an awareness group couldn't even say the word "breast" while talking at a university about mammograms and how to check for lumps.
They had to use the euphemism "cancer of women" to discuss a disease often shrouded in social stigma in this majority Muslim nation.
One in nine women in Pakistan will face breast cancer during their life, with the country itself having the highest rate of the disease across Asia, according to the breast cancer awareness group PinkRibbon, oncologists and other aid groups.
Yet discussing it remains taboo in a conservative, Islamic culture where the word breast is associated with sexuality instead of health and many view it as immoral for women to go to the hospital for screenings or discuss it even within their family.
Now, women like breast cancer survivor and prominent Pakistani politician Fehmida Mirza and groups are trying to draw attention to the disease and break the silence surrounding it.
"There's nothing to be shy about it," Mirza told The Associated Press in a recent interview. "No woman, no woman should die of ignorance and negligence."
No national database tracks breast cancer statistics but people who combat the disease say it kills nearly 40,000 women every year in Pakistan. That's about the same number as in the U.S., though Pakistan only has 180 million residents to the U.S.' 313 million.
With a health care system in shambles and more young women getting the disease, breast cancer rates only are expected to get worse. World Health Organization official Shahzad Aalam in Pakistan said it was difficult to determine the exact magnitude, but that the disease is rampant.
"It is the leading cancer killer among women," Aalam said.
Among Pakistani women there is very little knowledge about the disease. A study done at Rawalpindi General Hospital about breast cancer awareness among 600 women found nearly 70 percent totally ignorant of the disease, while 88 percent did not know about breast self-exams and 68 percent did not understand the significance of finding a lump in the breast.
"If women are being diagnosed with breast cancer, they don't even share the news with their family members," said Omar Aftab, who heads PinkRibbon in Pakistan, which put on the university presentation where organizers couldn't even say "breast."
"So, we're trying to break these taboos," he said.
Those cultural taboos have been one of the biggest issues preventing women from seeking treatment or even knowing about the disease. During an awareness event in Pakistan's capital, Islamabad, female students attending a breast cancer lecture demanded the men leave.
"It will take very long for us to discuss these issues openly," said one female student who requested anonymity because she feared her family wouldn't like her speaking about the issue.
Another challenge is Pakistan's abysmal health care sector that is starved for money, the latest technology and drugs. Oncologist Saira Hasan at Shifa International Hospital in Islamabad said most major hospitals lack a screening center or mammogram facility. Many patients first go to a traditional healer and by the time they visit a reputable doctor, the disease is often too far advanced to treat, Hasan said.
Women in the developing world, like Pakistan, tend to die at greater rates than in more developed countries because the disease is generally detected later and health care options aren't as good.
Hasan said several factors have contributed to the rise in the disease - above all the cultural taboos. Breast cancer survivor Sameera Raja, who owns an art gallery in southern Karachi and supports women facing breast cancer, says that it has to be changed.
"You're surprised to hear how women actually sit on things," Raja said. Recalling how a woman would feel too embarrassed to talk about it even with her husband, she said: "Don't hide behind closed doors."
Unlike in the U.S. where celebrities like singer Sheryl Crow or actress Christina Applegate have freely discussed their fight with breast cancer, few such public figures have come forward in Pakistan. That's changed with Mirza, though she had to delay her treatment for three months after she was diagnosed in March 2012 to handle her work, which included how to rule on whether a criminal conviction against the serving prime minister should disqualify him from politics.
"There was lot of pressure on me, work pressure," she said. "Everybody (would) say it's an excuse I'm using to run away."
Mirza described her friends and family being shocked by the diagnosis, as the cancer is considered by many as a death sentence. But during her diagnosis and treatment, she attended international conferences, ruled on the then-prime minister's case and later ran for re-election and won while undergoing chemotherapy.
She now uses her position in parliament to advocate for women's health issues. She plans to propose a bill making it mandatory for women to have breast cancer screenings and mammograms yearly, as well as to teach girls in schools to do breast exams themselves. She also pushed the health ministry to explain why there is no national database on breast cancer deaths.
"I think the role models will have to come forward," Mirza said. "That is one reason I had to."
Associated Press writers Adil Jawad in Karachi, Pakistan, and Zaheer Babar in Lahore, Pakistan, contributed to this report.
WASHINGTON (AP) -- The chemical spill that contaminated water for hundreds of thousands in West Virginia was only the latest and most high-profile case of coal sullying the nation's waters.
For decades, chemicals and waste from the coal industry have tainted hundreds of waterways and groundwater supplies, spoiling private wells, shutting down fishing and rendering streams virtually lifeless, according to an Associated Press analysis of federal environmental data.
But because these contaminants are released gradually and in some cases not tracked or regulated, they attract much less attention than a massive spill such as the recent one in West Virginia.
"I've made a career of body counts of dead fish and wildlife made that way from coal," said Dennis Lemly, a U.S. Forest Service research biologist who has spent decades chronicling the deformities pollution from coal mining has caused in fish.
"How many years and how many cases does it take before somebody will step up to the plate and say, `Wait a minute, we need to change this'?"
The spill of a coal-cleaning chemical into a river in Charleston, W.Va., left 300,000 people without water. It exposed a potentially new and under-regulated risk to water from the coal industry when the federal government is still trying to close regulatory gaps that have contributed to coal's legacy of water pollution.
From coal mining to the waste created when coal is burned for electricity, pollutants associated with coal have contaminated waterways, wells and lakes with far more insidious and longer-lasting contaminants than the chemical that spilled out of a tank farm on the banks of the Elk River.
Chief among them are discharges from coal-fired power plants that alone are responsible for 50 percent to 60 percent of all toxic pollution entering the nation's water, according to the Environmental Protection Agency.
Thanks to even tougher air pollution regulations underway, more pollution from coal-fired power plants is expected to enter the nation's waterways, according to a recent EPA assessment.
"Clean coal means perhaps cleaner atmosphere, but dirtier water," said Avner Vengosh, a Duke University researcher who has monitored discharges from power plant waste ponds and landfills in North Carolina.
In that state, Vengosh and other researchers found contaminants from coal ash disposal sites threatening the drinking water for Charlotte, the nation's 17th-largest city, with cancer-causing arsenic.
"It is kind of a time bomb that can erupt in some kind of specific condition," Vengosh said. The water shows no signs of arsenic contamination now.
In southeastern Ohio, tainted water draining from abandoned coal mines shuttered a century ago still turns portions of the Raccoon Creek orange with iron and coats the half-submerged rocks along its path white with aluminum.
Public drinking water systems in 14 West Virginia counties where mining companies are blasting off mountaintops to get to coal seams exceeded state safe drinking water standards seven times more than in nonmining counties, according to a study published in a water quality journal in 2012. The systems provided water for more than a million people.
The water quality monitoring in mining areas is so inadequate that most health violations likely were not caught, said Michael Hendryx, the study's author and a professor of applied health at Indiana University.
The EPA, in an environmental assessment last year, identified 132 cases where coal-fired power plant waste has damaged rivers, streams and lakes, and 123 where it has tainted underground water sources, in many cases legally, officials said.
Among them is the massive failure of a waste pond at a Tennessee Valley Authority power plant in 2008. More than 5 million cubic yards of ash poured into a river and spoiled hundreds of acres in a community 35 miles west of Knoxville.
Overall, power plants contributed to the degradation of 399 bodies of water that are drinking water sources, according to the EPA.
There are no federal limits on the vast majority of chemicals that power plants pipe directly into rivers, streams and reservoirs. The EPA just last year proposed setting limits on a few of the compounds, the first update since 1982. More than five years after the Tennessee spill, the EPA has yet to issue federal regulations governing the disposal of coal ash.
Experts say the agency is playing catch-up to solve a problem that began when it required power plants in the 1990s to scrub their air pollution to remove sulfur dioxide. An unintended consequence was that the pollutants captured were dumped into landfills and ponds, many unlined, where they seeped into underground aquifers or were piped into adjacent rivers, reservoirs and lakes.
"As you are pushing air rules that are definitely needed, you need to think of the water. And they didn't," said Eric Schaeffer, a former EPA enforcement official. "Now they are running after the problem."
He now heads the Environmental Integrity Project, a group whose research has uncovered previously unknown sites of contamination from power plant waste pits.
The federal government has in recent years issued the first-ever regulations for mercury released from power plant smokestacks, the largest source of mercury entering waterways. The EPA has stepped up its review of mountaintop mining permits, to reduce pollution.
"Coal-related pollution remains a significant contributor to water quality pollution across the United States," said Alisha Johnson, an EPA spokeswoman. "The EPA's efforts have yielded significant improvements, but significant work still remains."
On the mining side, a review of federal environmental enforcement records shows that nearly three-quarters of the 1,727 coal mines listed haven't been inspected in the past five years to see if they are obeying water pollution laws. Also, 13 percent of the fossil-fuel fired power plants are not complying with the Clean Water Act.
Many mines don't even report their discharges of selenium, although researchers have found the chemical near mines at levels where it can cause deformities and reproductive failure in fish.
A study in the journal Science in 2010 found that 73 of 78 West Virginia streams in mountaintop mine removal areas had selenium levels higher than the official threshold for fish life. Higher levels of selenium - a natural component of coal that seeps from rock when water runs through it - often means fish don't reproduce or have deformed, even two-headed, offspring, Lemly said.
University of Maryland environmental sciences professor Margaret Palmer spent much of the weekend that Charleston was without water testing the Stillhouse Branch stream near Clay, W.Va., just below a mountaintop removal coal mine. She said her tests showed the water was too salty from the rocks from the mine.
"It's like a desert with a few water rats in it," Palmer said. "The organisms that do live in (these streams), you think of them like water rats. Only the really hearty ones survive."
Efforts by the EPA to ease the problem, by requiring mine permits to be judged by a measure of the saltiness in downstream water, have been vacated by a federal court. That decision is under appeal.
A spokesman for the National Mining Association said the industry operates in accord with extensive and rigorous permitting guidelines.
Pollution still enters the environment from coal mined decades ago.
The EPA estimates 12,000 river miles are tainted by acid mine drainage from long-shuttered coal mines. One of them is Raccoon Creek in southeastern Ohio.
"These mines have been abandoned for a hundred years," said Amy Mackey, Raccoon Creek's watershed coordinator. "There is no one to fall back on."
States take the lead on the water pollution front. But advocacy groups from at least three states in coal country - Kentucky, West Virginia and Indiana - have asked the EPA to step in, arguing that state officials aren't doing enough.
Follow Dina Cappiello on Twitter: WWW.TWITTER.COM/DINACAPPIELLO
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