5 Things to Know About AHCA, the New House Republican Health Care Bill That Just Passed

This article originally appeared on Money. 

The Republican bill to repeal and replace Obamacare narrowly passed the House of Representatives on Thursday, advancing a plan that would gut health coverage for millions of Americans while delivering tax cuts to the rich.

The American Health Care Act, as the bill is called, had been tweaked in several ways since it was pulled from a House vote in March after failing to garner enough support. In making changes, Republican leaders tried to appease both hardline conservatives who thought the previous version was too much like Obamacare (aka, the Affordable Care Act or ACA) and moderates who worried about people losing coverage.

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But the nonpartisan Congressional Budget Office (CBO) has not yet scored the revised bill, so lawmakers voted without key projections on how the legislation would affect the number of insured, premium costs, the federal budget, and other measures. The last CBO score—delivered in response to the prior iteration of the bill—estimated that the legislation would increase the number of uninsured people overall by 24 million by 2026.

Proponents, including House Speaker Paul Ryan, say the bill will restore choice to consumers and lower premiums that spiraled out of control under Obamacare. But critics counter that the bill’s effects on premiums would vary greatly based on an individual’s situation, and that weakened consumer protections could ultimately hurt everyone, including those with employer coverage.

Generally speaking, younger, healthy people would likely see their premiums decline under the Obamacare replacement, while older and less healthy people would see them rise. Young people can continue to remain on their parents’ health insurance until age 26. Yet people will no longer be forced to pay a penalty if they go without health insurance for more than a short stretch—the bill does away with Obamacare’s “individual mandate,” but includes other incentives for people to maintain their coverage.

RELATED: 50 Health Issues That Count as a Pre-existing Condition

Here’s what you need to know about the bill, which continues next to the Senate. There, it faces new challenges and likely revisions before any vote. If it passes the Senate, President Donald Trump is expected to sign the bill into law.

1. Essential Health Benefits Could Disappear

Obamacare created a list of 10 essential health benefits that health plans must offer, including maternity care and mental health care, which were routinely excluded from pre-Obamacare policies on the individual market. The amended American Health Care Act would allow states to apply for a waiver to define their own essential health benefits starting in 2020. There are several concerns with this approach. One is that insurance carriers would likely decline to offer costly benefits if they’re not required to, Linda Blumberg and John Holahan of the Urban Institute write in a recent report. Or if they do, they’ll offer them at such a high price that coverage will be unaffordable for most consumers.

Another concern is that, without essential health benefits, coverage for pre-existing conditions becomes meaningless. Obamacare detractors, including President Trump, are quick to say they want to retain coverage for pre-existing conditions. But if you have cancer and your policy doesn’t cover chemotherapy—because it no longer has to offer comprehensive benefits—then practically speaking, you’re not covered even though you can technically buy a policy.

What’s more, weakening of essential health benefits could also affect people with health coverage through their jobs, experts say. Obamacare required all health insurance plans, including those provided through an employer, to have an out-of-pocket maximum limiting the amount that the patient would have to pay in a given year. But that ceiling only applies to benefits that are considered essential health benefits. Under the GOP bill, employers could choose any state’s definition of essential health benefits, and those seeking to lower costs could gravitate toward the skimpier ones. This would leave workers vulnerable to catastrophic expenses if they get a serious injury or health diagnosis.

RELATED: House Votes to Repeal and Replace Obamacare

2. Medicaid Would be Cut

The American Health Care Act would radically change Medicaid, by phasing out the Obamacare Medicaid expansion that extended health coverage to more than 10 million lower-income Americans.

States would be allowed to continue to enroll people into the expanded Medicaid program until 2020. Then, it will “freeze,” and no other enrollees can be added, the thinking being people would eventually drop out of the program as they earn more money.

Beyond that, the bill would restructure all of Medicaid, not just the parts that Obamacare touched. The American Health Care Act would slash federal Medicaid spending by about $840 billion over 10 years, according to CBO projections. This would likely lead to benefit cuts for the 74 million Americans who rely on the program, including lower-income beneficiaries, as well as, the disabled and elderly people who have exhausted their assets.

These cuts to Medicaid would help fund that tax cuts that the bill grants to wealthy Americans. Obamacare levied certain taxes on the wealthy to help fund the premium subsidies that help make insurance more affordable for the 85% of the people on the individual marketplace who receive them. Yet the American Health Care Act rolls back the tax increases, and cuts to Medicaid will help to make up some of that lost revenue.

3. Pre-Existing Conditions Wouldn’t be Adequately Protected

After initially promising to protect people with pre-existing conditions from exorbitant premiums and deductibles, the House plan would allow insurers to once again charge sick people more for coverage under certain circumstances.

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Insurers still cannot deny coverage outright to people with pre-existing conditions, as they could before the passage of the ACA. However, they will be able to charge significantly higher premiums once again if individuals do not maintain continuous coverage. States can apply for a waiver to the ACA’s community rating provision, which banned charging sick people in a community more for insurance than “healthier” people in the community (with exceptions for age and tobacco usage). In order to receive the waiver, states would receive money from the Patient and State Stability Fund to create things like high-risk pools.

These high-risk pools are intended to help bring down costs for sick people, but a recent report from the AARP found that premiums could exceed $25,000 per year for people in these pools, pricing many people out. The AHCA has $138 billion over ten years earmarked for the pools, which is not nearly enough to help subsidize costs, according to experts, even with an additional $8 billion that was added to the pot at the last minute.

4. Tax Credits Would Decrease for Most People

Tax credits to pay for individual coverage varied based primarily on income, as well as age and geographical region, under Obamacare, and 85% of enrollees receive help paying for coverage. In the AHCA, subsides depend almost exclusively on age, with all individuals in a certain age range receiving the same amount of support. The credits are phased out for the highest earners: they start decreasing when an individual earns $75,000, or $150,000 for joint filers.

Overall, the AHCA dramatically reduces the amount of money people will receive to help pay for their insurance, excepting the youngest, healthiest enrollees. This is the age breakdown for subsidies:

  • 30 and Under: $2,000 per year
  • 30 to 40: $2,500 per year
  • 40 to 50: $3,000 per year
  • 50 to 60: $3,500 per year
  • 60 and Over: $4,000 per year

Compared to the ACA’s credits, this structure benefits young healthy people, while hurting older people as well as sick young people. Lower-income older people would be hit particularly hard, as the fixed dollar subsidy won’t go as far in covering their costs as the income-based one. In 2026, a 64-year-old making $26,500 would owe a sizable $19,500 in annual premiums under Ryan’s plan, versus $15,300 under Obamacare, according to CBO projections. Meanwhile, the difference in subsidies would mean that the consumer pays just $1,700 out-of-pocket for premiums under Obamacare, versus $14,600 under the American Health Care Act.

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5. Women’s Health Access Would Take Extra Hits

Though not explicitly stated, the AHCA aims to defund Planned Parenthood, the largest network provider of women’s health care in the country, by denying reimbursements from Medicaid and Title X (a federal program for family planning) funding for preventative and primary care. That could lead to as many as 650,000 women losing access to preventive care.

The waivers for pre-existing conditions and essential health benefits would also disproportionately affect women: things like maternity and newborn care could be on the chopping block, as well as birth control coverage. Other services that are currently considered preventive care that could change if essential health benefits are rejiggered include breast pumps, domestic violence screening and counseling, mammograms, newborn care, screenings for cervical cancer, STI counseling and well-woman visits. A recent study from the Kaiser Family Foundation found that because of increased birth control coverage, out-of-pocket prescription costs are actually on the decline—and that too would be reversed.

At the same time, sexual assault, domestic violence, pregnancy, C-section, postpartum depression, and eating disorders are all conditions affecting significantly more women than men (though not exclusively women), that could be considered pre-existing conditions once again.

The bill could put domestic violence victims at even more risk. As MONEY reported previously,

Under Obamacare, couples have to file taxes jointly to receive a tax credit—unless they are victims of domestic abuse, domestic violence, or spousal abandonment. The AHCA doesn’t account for this and requires all couples to file jointly to receive a tax credit, without exception.

Finally, women also make up the majority of Medicaid recipients, and nearly half of all births are covered by Medicaid.

Source: Mind-Body

50 Health Issues That Count as a Pre-existing Condition

This article originally appeared on Money. 

The Republican plan to repeal and replace the the Affordable Care Act (ACA), which narrowly passed a vote in the House today, rolls back protections for people with pre-existing conditions, which could increase health care costs for an estimated 130 million Americans.

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The American Health Care Act stipulates that states can allow insurers to charge people with pre-existing conditions more for health insurance (which is banned under the ACA) if the states meet certain conditions, such as setting up high-risk insurance pools. Insurers still cannot deny people coverage outright, as was a common practice before the ACA’s passage, but they can hike up premiums to an unaffordable amount, effectively pricing people out of the market.

In fact, premiums could reach as high as $25,700 per year for people in high-risk pools, according to a report from AARP. People who receive insurance through their employer would not be affected, unless they lost their job or moved to the individual insurance market for some other reason.

But what counts as a pre-existing condition? While it depends on the insurer—they have the right to choose what counts as “pre-existing”—these ailments and conditions were universally used to deny people coverage, according to the Kaiser Family Foundation, a nonprofit focusing on health care research.

  • AIDS/HIV
  • Alcohol or drug abuse with recent treatment
  • Alzheimer’s/dementia
  • Anorexia
  • Arthritis
  • Bulimia
  • Cancer
  • Cerebral palsy
  • Congestive heart failure
  • Coronary artery/heart disease, bypass surgery
  • Crohn’s disease
  • Diabetes
  • Epilepsy
  • Hemophilia
  • Hepatitis
  • Kidney disease, renal failure
  • Lupus
  • Mental disorders (including Anxiety, Bipolar Disorder, Depression, Obsessive Compulsive Disorder, Schizophrenia)
  • Multiple sclerosis
  • Muscular dystrophy
  • Obesity
  • Organ transplant
  • Paraplegia
  • Paralysis
  • Parkinson’s disease
  • Pending surgery or hospitalization
  • Pneumocystic pneumonia
  • Pregnancy or expectant parent (includes men)
  • Sleep apnea
  • Stroke
  • Transsexualism

But Cynthia Cox, Kaiser’s associate director, notes that the above list is a conservative sampling of all of the issues and maladies that insurers could count as pre-existing conditions. “There are plenty of other conditions, even acne or high blood pressure, that could have gotten people denied from some insurers but accepted and charged a higher premium by other insurers” says Cox.

Here are some examples of those other conditions that experts have noted could hike premiums:

  • Acid Reflux
  • Acne
  • Asthma
  • C-Section
  • Celiac Disease
  • Heart burn
  • High cholesterol
  • Hysterectomy
  • Kidney Stones
  • Knee surgery
  • Lyme Disease
  • Migraines
  • Narcolepsy
  • Pacemaker
  • Postpartum depression
  • Seasonal Affective Disorder
  • Seizures
  • “Sexual deviation or disorder”
  • Ulcers

The left-leaning Center for American Progress notes that high blood pressure, behavioral health disorders, high cholesterol, asthma and chronic lung disease, and osteoarthritis and other joint disorders are the most common types of pre-existing conditions.

Just how expensive are pre-existing conditions? A recent report from the Center for American Progress found that insurers could charge people with metastatic cancer as much as $142,650 more for their coverage, a 3,500% increase.

Source: Mind-Body

House Votes to Repeal and Replace Obamacare

This article originally appeared on Time.com. 

House Republicans voted on Thursday to repeal Obamacare, making good on a seven-year campaign promise that could reshape health care in the United States and dramatically reduce the number of Americans with health insurance.

If the Republican bill passes in the Senate, it will reorganize insurance markets and affect coverage for many millions of Americans.

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“Seven years of Obamacare is enough,” House Speaker Paul Ryan wrote on Twitter Thursday morning.

The vote comes nearly six weeks after House Republicans had to pull an earlier version due to disagreements between moderates and conservatives in their caucus. The bill has since been amended twice, though the broad outlines remain the same.

The bill weakens protections for people with pre-existing medical conditions. It rolls back the expansion of Medicaid and cuts taxes on the wealthy. It also significantly reduces federal assistance to lower-income Americans paying for health insurance, and it defunds Planned Parenthood.

In addition, it repeals the Obamacare “individual mandate,” the rule requiring people to buy insurance.

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“This bill brings choice and competition back into the health care marketplace and puts health care decisions back in the hands of patients and doctors,” Rep. Diane Black said on the floor of the House. “It’s been a winding road to get to this point, but we’re here today to fulfill the promise we made to the American people.”

Called the American Health Care Act, the bill was passed on Thursday morning without a score from the nonpartisan Congressional Budget Office, which is highly unusual for major legislation. But a similar, earlier version of the Republican bill would have reduced the number of insured by 24 million people by 2026 and raised premiums by 15 to 20% before they began to drop, according to the CBO.

Democrats decried the bill, saying it was rushed through the House without enough review and would damage the health care system. “Republicans are maliciously again attempting to destroy healthcare and coverage for the American people,” said House Minority Leader Nancy Pelosi.

The vote on Thursday morning was a nailbiter.

RELATED: Why Multitasking Is a Bad Idea

Many Republicans — including those who voted for it — were privately unhappy with health care bill. For conservatives who wanted to repeal Obamacare fully, it does not go far enough; for moderates, it is too harsh on lower- and middle-income Americans. The bill is a “technocratic crap sandwich,” one Republican lawmaker said.

In addition, the bill comes without a score from the CBO, and some members felt the bill was rushed to the floor without members having time to understand the effects of the bill.

Rep. Peter King of New York said he had not read the latest amendment just hours before the vote, but that he would vote in favor anyway based on his discussions with Republican leadership. “You have to strike while you can,” King said.

For some, assurances from leadership were not enough. “I’m certainly not going to vote on a bill of this magnitude that hasn’t been fully scored by the Congressional Budget Office and whose price tag is unknown,” said Rep. Mike Coffman, Republican of Colorado.

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But Republicans in the House, embarrassed by their failed effort to pass the bill at the end of March, were determined to push the health care on to the Senate. It will almost certainly face a significant overhaul in the Senate, and then be sent to a joint-chamber conference committee, where changes are reconciled.

Republican House members described the bill as a first-draft effort, necessary to begin the repeal of Obamacare. Waiting any longer, some Republicans said, could cause the bill to fail.

“If we couldn’t get this across the floor it would all stop here today,” said Rep. Tom Cole of Oklahoma. “Nobody should look at this as the be-all and end-all. It’s the first step, not the last step.”

“I don’t think time would be our friend. We want to get it over to the Senate so they can start their job,” said Rep. Chris Collins of New York.

But as a legislative blueprint, the House bill significantly weakens the protections established under Obamacare for Americans with preexisting conditions. It also will cut aid to lower-income Americans, making health care subsidies based on age, rather than income.

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Those who stand to gain immediately include younger and healthier insurance buyers in the open marketplace, and the wealthiest taxpayers, who will see a significant tax cut.

The farthest-reaching effect of the American Health Care Act, however, may be provisions that roll back the expansion of Medicaid beginning in 2018. Obamacare expanded Medicaid for states who chose to opt-in to everyone making up to 138% of the poverty line, expanding coverage in those states by well over 10 million people.

Halting the Medicaid expansion in those states, combined with the bill’s restructuring of health insurance subsidies, will mean that people making minimum wage and slightly more will experience the sharpest drop in coverage.

“The AHCA would lead to catastrophic coverage losses among those right above the poverty line,” said Dr. Julie Donohue, director of the Medicaid Research Center at the University of Pittsburgh Health Policy Institute. “While individuals right above poverty-level could technically purchase coverage on the marketplace, such coverage will be out of reach for nearly all.”

President Trump has promised the bill would cover those with preexisting conditions, but the bill would allow states to let insurers charge people with preexisting conditions higher premiums.

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Thursday’s House vote ensures that the Republican effort to repeal Obamacare does not end. But the Republican victory on Thursday may be setting lawmakers up for a major defeat in 2018.

The Republican health care bill is deeply unpopular, with just 17% of Americans approving of the bill, according to a poll from late March. The bill was opposed by AARP as well as the American Medical Association, health groups and hospitals. A majority of Americans want Congress to fix Obamacare rather than repeal it outright.

Democrats believe the bill’s passage on Thursday will help set up the party for a wave of congressional election victories next year. Even as they lambasted the Republican vote, Democrats were preparing to target the moderate Republicans in swing districts who voted for the bill.

“You vote for this bill, you’re walking the plank,” House Minority Leader Nancy Pelosi told Republicans on the house floor.

The bill “is going to provide a great civics lesson for America,” she said. “Most Americans don’t know who their Congressperson is. But they will now.”

 

Source: Mind-Body

Are Digital Doctors the Future?

This article originally appeared on Time.com. 

Doctor’s appointments can be a chore: It takes nearly 20 days on average to get an appointment with a family physician in the U.S., for instance. But it doesn’t have to be that onerous. New technologies that allow people to see doctors in just minutes—on their smartphone—have the potential to change health care delivery in the U.S..

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At Fortune’s Brainstorm Health conference in San Diego, two companies—Doctor on Demand and Healthy.io—revealed how they are making health care systems that are centered around patients’ schedules.

Doctor on Demand connects users with a variety of doctors over video chat. Doctors can see patients at any time of day over their smartphone, and send prescriptions to nearby pharmacies.

RELATED: Should You Trust Apps That Let You Video-Chat With a Doctor?

On Wednesday, Doctor on Demand announced that it is partnering with LabCorp and Quest Diagnostics to offer lab testing services. If a doctor sees a patient over video chat and determines they need lab work, the doctor can order the tests and direct the patient to a nearby lab for testing. Patients can choose a lab that works best for them based on location and costs.

“We are providing a lot of transparency and putting the patient in control of where they go to get that lab,” said Hill Ferguson, the CEO of Doctor on Demand. “It’s very different from the current experience and being told by your provider you need to go here at this time.”

Healthy.io, is also changing the testing game by turning people’s smartphones into medical devices. Through the company’s app Dip.io, people receive a testing kit at home, pee on a testing strip, and use a smartphone camera to scan the results and send them to a doctor for analysis. The company says it’s working to get FDA-approval for use in the United States.

RELATED: This Is What Real Heart Doctors Do Every Day to Stay Healthy

“Whatever you can do at home would allow for the physician at the hospital to be more effective,” said Yonatan Adiri, founder and CEO of Healthy.io.

But are people really ready to give up their in-person doctor’s appointments? Ferguson thinks so. “I think there’s something gained,” he said. “One-hundred percent of the doctor patient interaction [on Doctor on Demand] is eye-to-eye contact.”

Source: Mind-Body

Why Multitasking Is a Bad Idea

This article originally appeared on Fortune.com. 

Remembering every word of Abraham Lincoln’s historic Gettysburg Address is difficult. It’s even more challenging when you are dealing with distractions.

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At Fortune’s Brainstorm Health conference in San Diego on Tuesday, Time Inc.’s chief content officer and Fortune president Alan Murray tried to write the famous Civil War speech by memory while being interviewed on the phone by Cleveland Clinic CEO Toby Cosgrove.

The demonstration’s purpose was to show that people “are not very good at multitasking” and that even trying to do merely two things at once is “not an easy thing to do,” said Fortune editor Clifton Leaf. This is despite the fact that the average person shifts their attention span roughly 565 times a day as technology and social networks like Facebook have become increasingly part of many people’s lives, Leaf later added.

Before Cosgrove called, Murray appeared to be at ease in front of the audience as he wrote the speech on a laptop. But after Cosgrove started peppering Murray with questions, Murray’s concentration waned.

“You seemed to have paused,” Leaf noted when Murray was seemingly befuddled as he focused on writing while Cosgrove kept pestering him with questions about leading Time, Inc.

RELATED: Here’s How You Can Tame Your Distracted Mind

Indeed, Murray found it hard to listen and write at the same time, and admitted he was having problems recalling and writing the speech.

“Now I know I would have rather done the virtual reality demonstration,” Murray joked, referring to having participated in the multitasking demo and not another one.

Indeed, sometimes it helps to sit down and focus on the task at hand rather than doing too many things at once.

Source: Mind-Body

Here's How You Can Tame Your Distracted Mind

This article originally appeared on Fortune.com. 

How can you tame your distracted mind?

It’s not easy these days, given that many of us have a smartphone—if not smartphones, plural—and the ability to be accessible, connected, and theoretically productive around-the-clock. According to Adam Gazzaley, a professor in neurology, physiology and psychiatry at the University of California-San Francisco—and the author of The Distracted Mind: Ancient Brains in a High-Tech World—the evidence is all around us: 95% of people multi-task, and on average, we do so for one-third of the day. Some young people multitask with up to seven devices at once. Having grown accustomed to constant stimulation, our tolerance for boredom is lower than ever, tested even while waiting in a short line at the local grocery store.

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Gazzaley, who spoke at Fortune‘s Brainstorm Health conference in San Diego on Tuesday, points out our modern state is both natural (we are by nature information-seeking creatures) and sub-optimal. That is, the day’s many distractions—from working on multiple web windows to falling into the Facebook “sinkhole”—mess with our cognitive control. The resulting limitations in cognitive control—i.e., attention, working memory and goal management—in turn interfere with what Gazzaley considers the pinnacle of human brain evolution: our high-level goal setting abilities.

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Gazzaley makes clear that technology did not create this distracting “interference” in the brain, but he says it has aggravated it, and that it has impacted all sorts of brain function, from the way our memory works to the way emotion gets regulated. Those changes in turn affect how we act in the real world, whether it be at work or in relationships or considering our own personal safety.

“There are many examples of decreased performance quality and productivity, and an increase in stress,” says Gazzaley of what he has labeled “the ancient brain in a high-tech world.”

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Gazzaley says there are two ways for people to take back control: modifying behavior or enhancing the brain. The former involves a greater level of personal awareness—multitasking is not necessarily a bad thing; knowing when to multitask is key to winning the battle. He recommends we all take a break from multitasking—nature and exercise are good for concentrating the mind; so are attempts at “single-tasking.” (He concedes this can be hard for people, and he advises a “baby step” approach to assuming singular focus.)

In terms of enhancing the brain, both physical and cognitive exercises can help. Gazzaley, with Akili, a company he co-founded, have also been developing a video game that can help the brain better deal with distraction; it’s currently in a phase III clinical trial, and he hopes it will soon be the first non-drug treatment for ADHD, as well as the first video game prescribed for medical purposes.

Source: Mind-Body

How Worrying Can Actually Be Good for You

This article originally appeared on RealSimple.com. 

Good news for worrywarts everywhere: Your fretting and fussing can actually have health benefits, according to a new scientific paper. Not only can worrying serve as an emotional buffer against worst-case scenarios, say researchers, but it can also be a strong motivator for proactive, healthy behaviors.

The article, published in Social and Personality Psychology Compass, also argues that people who worry a lot may perform better in school or at work, and that they engage in more successful problem solving. “I think there’s a lack of understanding when people are made to feel bad for worrying, or told to ‘just stop worrying about it,’” says author Kate Sweeny, Ph.D., psychology professor at the University of California, Riverside.

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While worrying generally gets a bad rap, it does make sense that the habit could be protective: Naturally anxious people might be expected to follow health and safety advice to a T, like wearing their seatbelts, applying sunscreen every few hours, and keeping up-to-date with doctor’s appointments and screenings, for example.

And that’s partially correct, says Sweeny, although the truth is more nuanced: In one study referenced in her article, women who reported moderate amounts of worry—compared to those with relatively low or high levels of worry—were the most likely to get screened for cancer. “It seems that both too much and too little worry can interfere with motivation,” she says, “but the right amount of worry can motivate without paralyzing.”

In fact, Sweeny suggests a three-step explanation for worry’s motivating effects: First, it serves as a cue that a situation requires action. Second, it keeps that situation at the front of people’s minds. And third, the unpleasant feeling prompts them to do something about it, in order to feel better.

RELATED: This Is the Fastest Way to Calm Down

Worrying about a future outcome can also help people brace for bad news, or make good news seem even better by comparison, Sweeny writes. That may be why even optimists tend to expect the worst about uncertain news, as her previous research has found.

Sweeny stresses, however, that extreme worrying is still harmful to one’s health; rumination and repetitive thoughts have been associated with depressed mood, poor physical health, and even mental illness.

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She doesn’t advocate for excessive worrying, but she does hope to provide reassurance to the occasional worrier, the nitpicky planner, and the overly prepared person who has to mentally run though every detail of a scenario while others simply kick back and relax.

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“I think the primary message is that when you’re feeling worried, take a minute to think about whether those thoughts are productive—maybe there are things you should be doing and preparing for to prevent bad things from happening—and in that case it’s a good thing,” she says. (If you’ve done all that and you’re still stressed out, then maybe try to distract yourself and think about something else.)

Sweeny also adds that some people clearly don’t worry enough about certain things, like what could happen to them if they engage in unsafe or unhealthy behaviors. “If you find yourself not caring about those things, it’s worth asking yourself why you’re downplaying those risks,” she says. “In those cases, worrying the right amount is far better than not worrying at all.”

Source: Mind-Body

This $15 Product Makes Even the Most Unwearable Shoes Comfortable

This article originally appeared on RealSimple.com. 

Getting a new pair of shoes has always been a bittersweet occasion for me. Once the joy of finding that perfect pair—and the tiny, happy rush of the purchase—has worn off, I’m left to grapple with the comfort conundrum: those awful initial wears before your new shoes are broken in (or is it your feet that need breaking in?). Whether it’s the highest heels or the lowest flats, I’ve yet to find a pair that doesn’t literally rub me the wrong way, from the common heel blister, to the painful chafing on the tops of my toes, to those more unexpected issues like booties that bite at the ankle.

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That all changed after I hobbled into the office after a full day of running around New York City to different Fashion Week shows—in heels, of course (it’s a hazard of the job). Our kind associate fashion editor, Flavia Nunez, took pity on my poor feet, dug into her bag, and produced a small miracle.

A seasoned marathon runner, Flavia knows a thing or two about blisters (and shoes) and, thankfully, how to prevent and treat them. The product she handed over is from a brand called Compeed, that, unlike other bandage companies, focuses almost exclusively on blisters. At $9 for a pack of six, they’re a little more expensive than a traditional pack of self-adhesive strips, but hear me out—they’re well worth it. According to their website, the products “use hyrdrocolloid technology that fits like a second skin and stays on all day long.” They’re not kidding. The blister cushions certainly do feel like a second skin, are waterproof, adhere smoothly, do not budge, roll, or wrinkle, and will stay on for days, until you pull them off yourself. You’d probably spend the same amount on bandages that wind up needing to be constantly replaced.

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I now keep the conveniently-sized packs in my purse at all times. I'll pop one on at the first sign of chafing or rubbing, but the tiny pads also prevent blisters from happening in the first place—and instantly make the shoe in question wearable. Taking more unorthodox measures, I’ve also used the larger size on the balls of my feet for shoes that don’t have enough padding, put on a double layer to cushion an already-existing blister (immediate relief), and cut the cushions to size to fit an oddly shaped contour or wrap more neatly around a tormented toe.

They can be a little tricky to find in stores, but luckily we have Amazon for that—and yes, they are qualify for Prime.

Source: Mind-Body

5 Things To Know About The Health Issue That Could Shut Down The Government

This article originally appeared on Kaiser Health News. 

Congress must pass a bill this week to keep most of the government running beyond Friday, when a government spending bill runs out. It won’t be easy.

The debate over a new spending bill focuses on an esoteric issue affecting the Affordable Care Act.

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The question is whether Congress will pass — and President Donald Trump will sign — a bill that also funds subsidies for lower-income people who purchase health insurance under the law. These “cost-sharing reductions” (CSR) have become a major bargaining point in the negotiations between Republicans and Democrats, because the spending bill will require at least some Democratic votes to pass.

Here are five things to know about these cost-sharing subsidies: 

How are these subsidies different from the help people get to purchase insurance?

There are two types of financial aid for people who buy insurance from an ACA exchange. People with incomes up to four times the poverty line, or $81,680 for a family of three, are eligible for tax credits to help pay their premiums.

RELATED: Millions of Women Don’t Have Access to Fertility Treatments in the U.S.

In addition to that help, people with incomes up to two-and-a-half times the poverty line, or $51,050 for a family of three, get additional subsidies to help pay their out-of-pocket costs, including deductibles and copayments for care, as long as they purchase a silver-level plan. Insurance companies are required in their contracts with the government to provide these cost-sharing reductions to eligible people, then get reimbursed by the government.

Why are cost-sharing reductions suddenly front and center?

The fight dates to 2014, when Republicans in the House of Representatives filed suitagainst the Obama administration, charging that Congress had not specifically appropriated money for the cost-sharing subsidies and therefore the administration was providing the funding illegally.

A year ago, a federal district court judge ruled that the House was correct and ordered the payments stopped. However, she put that ruling on hold while the Obama administration appealed. That’s where things stood when Trump was inaugurated.

If the Trump administration drops the appeal, the funding would cease. However, Congress could also opt to approve funding the payments, which is what Democrats are pushing in the spending bill. 

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What would happen if these subsidies are stopped?

At the very least, ending the cost-sharing reductions in the middle of the year would cause a serious disruption in the insurance market. The payments are estimated at $7 billion this year, and $10 billion in 2018. They cover about 7 million people, about 58 percent of those purchasing coverage on the exchanges.

Many experts have predicted that if the subsidies end, some or all insurers might leave their markets entirely, leaving consumers with fewer, or possibly no, choices.

But even if they stay, the Kaiser Family Foundation estimates that insurers would have to raise premiums on the marketplace silver plans by an average of 19 percent in order to offset that loss of government reimbursement. (Kaiser Health News is an editorially independent program of the foundation.)

Ironically, ending the subsidies would actually cost the federal government more money. Premium increases to make up for the lost payments would in turn trigger bigger tax credits for the broader population eligible for help paying their premiums. Those larger tax credits would cost the federal government an estimated $2.3 billion above what it would save on the cost reduction subsidies next year, KFF projected.

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Who is pushing Congress to fund the subsidies?

In addition to Democrats in Congress who support the ACA, influential health-related groups are urging lawmakers to fund the cost-sharing reductions.

The coalition, which includes America’s Health Insurance Plans, the American Medical Association, the American Hospital Association and the U.S. Chamber of Commerce, points out that the uncertainty surrounding the future of the promised payments could not only disrupt this year’s insurance market, but next year’s as well.

“The window is quickly closing to properly price individual insurance products for 2018,” the groups wrote to Congress on April 12. Most insurers must decide whether they will participate in the health law’s market in 2018 by late June.

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Most Americans don’t support cutting the subsidies as part of a GOP strategy to force Democrats in Congress to help pass a new health law. A new poll reported 60 percent of those surveyed said the president “should not use negotiating tactics that could disrupt insurance markets and cause people to lose health coverage.” On the other hand, two-thirds of Republicans surveyed said Trump “should use whatever negotiating tactics necessary to win support for a replacement plan.”

What does the Trump administration think about this?

Good question. Trump and senior health officials have offered conflicting positions.

On April 10, unnamed officials told the New York Times and other outlets that the administration “is willing to continue paying subsidies” while the lawsuit remains pending, just as the Obama administration did. The next day, however, a spokeswoman for the Department of Health and Human Services disavowed that statement, saying that “the administration is currently deciding its position on this matter.”

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The day after that, Trump himself said in an interview with the Wall Street Journal that he was holding back a decision on the payments as leverage. “I don’t want people to get hurt,” he said. “What I think should happen — and will happen — is the Democrats will start calling me and negotiating.”

By the following week, administration officials were dangling the funding for the cost-sharing reductions in the spending bill as a trade for Trump’s request for funding for a border wall. “We don’t like those [subsidies] very much, but we have offered to open the discussions to give the Democrats something they want in order to get something we want,” budget director Mick Mulvaney said on Fox News Sunday. “We’d offer them $1 of CSR payments for $1 of wall payments.”

Democrats, however, are not buying what the administration is selling. “The White House gambit to hold hostage health care for millions of Americans, in order to force American taxpayers to foot the bill for a wall that the president said would be paid for by Mexico is a complete non-starter,” Senate Minority Leader Chuck Schumer (D-N.Y.) said in a written statement.

Complicating matters further, it is far from clear that Republicans in Congress want to end the cost-sharing payments.

The subsidies are “a commitment made by the government to the insurers and the people,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) said at a town hall meeting in his district, according to The Washington Post. “That needs to happen.”

 Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

Source: Mind-Body