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House Leaders ‘Came Up Short’ In Effort To Kill Obamacare

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.

“We came really close today, but we came up short,” he told reporters at a hastily called news conference.

When pressed about what happens to the federal health law, he added, “We’re going to be living with Obamacare for the foreseeable future.”

Ryan originally had hoped to hold a floor vote on the measure Thursday — timed to coincide with the seventh anniversary of the ACA — but decided to delay that effort because GOP leaders didn’t have enough “yes” votes. The House had been in session Friday while members debated parts of the bill.

The legislation was damaged by a variety of issues raised by competing factions of the party. Many members were spooked by reports by the Congressional Budget Office showing that the bill would lead eventually to 24 million people losing insurance, while some moderate Republicans worried that ending the ACA’s Medicaid expansion would hurt low-income Americans.

At the same time, conservatives, especially the hard-right House Freedom Caucus that often has needled party leaders, complained that the bill kept too much of the ACA structure in place. They wanted a straight repeal of Obamacare, but party leaders said that couldn’t pass the Senate, where Republicans don’t have enough votes to stop a filibuster. So they chose to use a complicated legislative strategy called budget reconciliation that would allow them to repeal only parts of the ACA that affect federal spending.

The decision came after a chaotic week of negotiations, as party leaders sought to woo more conservatives. Trump personally lobbied 120 members through personal meetings or phone calls, according to a count provided Friday by his spokesman, Sean Spicer. “The president and the team here have left everything on the field,” Spicer said.

On Thursday evening, Trump dispatched Office of Management and Development Director Mick Mulvaney to tell his former House GOP colleagues that the president wanted a vote on Friday. It was time to move on to other priorities, including tax reform, he told House Republicans.

“He said the president needs this, the president has said he wants a vote tomorrow, up or down. If for any reason it goes down, we’re just going to move forward with additional parts of his agenda. This is our moment in time,” Rep. Chris Collins (R-N.Y.), a loyal Trump ally, told reporters late Thursday. “If it doesn’t pass, we’re moving beyond health care. … We are done negotiating.”

Trump’s edict clearly irked some lawmakers, including the Freedom Caucus chairman, Rep. Mark Meadows (R-N.C), whose group of more than two dozen members represented the strongest bloc against the measure.

“Anytime you don’t have 216 votes, negotiations are not totally over,” he told reporters who had surrounded him in a Capitol basement hallway as he headed in to the party’s caucus meeting.

Shortly before Ryan’s press conference, Trump called Washington Post reporter Robert Costa to say they were pulling the bill back from consideration. Costa said the president seemed at ease with the decision and did not blame Ryan for the defeat.

Trump, Ryan and other GOP lawmakers tweaked their initial package in a variety of ways to win over both conservatives and moderates. But every time one change was made to win votes in one camp, it repelled support in another.

The White House on Thursday accepted conservatives’ demands that the legislation strip federal guarantees of essential health benefits in insurance policies. But that was another problem for moderates, and Democrats suggested the provision would not survive in the Senate.

Republican moderates in the House — as well as the Senate — objected to the bill’s provisions that would shift Medicaid from an open-ended entitlement to a set amount of funding for states that would also give governors and state lawmakers more flexibility over the program. Moderates also were concerned that the package’s tax credits would not be generous enough to help older Americans — who could be charged five times more for coverage than their younger counterparts — afford coverage.

The House package also lost the support of key GOP allies, including the Club for Growth and Heritage Action. Physician, patient and hospital groups also opposed it.

It’s not clear what will happen next to the Republican effort to overturn or modify Obamacare. But White House officials told members Thursday that if they couldn’t pass the legislation, the president wanted to turn to other priorities, including tax reform. “The president understands this is it,” Spicer said. “We had this opportunity to — to change the trajectory of health care, to help improve — put a health care system in place and to end the nightmare that Republicans have campaigned on called Obamacare.”

Not A Done Deal: House Leaders ‘Came Up Short’ In Effort To Kill Obamacare

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to secure enough support to pass their plan to repeal and replace the Affordable Care Act.

House Speaker Paul Ryan pulled the bill from consideration after he rushed to the White House to tell President Donald Trump that there weren’t the 216 votes necessary for passage.

“We came really close today, but we came up short,” he told reporters at a hastily called news conference.

When pressed about what happens to the federal health law, he added, “We’re going to be living with Obamacare for the foreseeable future.”

Ryan originally had hoped to hold a floor vote on the measure Thursday — timed to coincide with the seventh anniversary of the ACA — but decided to delay that effort because GOP leaders didn’t have enough “yes” votes. The House had been in session Friday while members debated parts of the bill.

The legislation was damaged by a variety of issues raised by competing factions of the party. Many members were spooked by reports by the Congressional Budget Office showing that the bill would lead eventually to 24 million people losing insurance, while some moderate Republicans worried that ending the ACA’s Medicaid expansion would hurt low-income Americans.

At the same time, conservatives, especially the hard-right House Freedom Caucus that often has needled party leaders, complained that the bill kept too much of the ACA structure in place. They wanted a straight repeal of Obamacare, but party leaders said that couldn’t pass the Senate, where Republicans don’t have enough votes to stop a filibuster. So they chose to use a complicated legislative strategy called budget reconciliation that would allow them to repeal only parts of the ACA that affect federal spending.

The decision came after a chaotic week of negotiations, as party leaders sought to woo more conservatives. Trump personally lobbied 120 members through personal meetings or phone calls, according to a count provided Friday by his spokesman, Sean Spicer. “The president and the team here have left everything on the field,” Spicer said.

On Thursday evening, Trump dispatched Office of Management and Development Director Mick Mulvaney to tell his former House GOP colleagues that the president wanted a vote on Friday. It was time to move on to other priorities, including tax reform, he told House Republicans.

“He said the president needs this, the president has said he wants a vote tomorrow, up or down. If for any reason it goes down, we’re just going to move forward with additional parts of his agenda. This is our moment in time,” said Rep. Chris Collins (R-N.Y.), a loyal Trump ally, told reporters late Thursday. “If it doesn’t pass, we’re moving beyond health care. … We are done negotiating.”

Trump’s edict clearly irked some lawmakers, including the Freedom Caucus chairman, Rep. Mark Meadows (R-N.C), whose group of more than two dozen members represented the strongest bloc against the measure.

“Anytime you don’t have 216 votes, negotiations are not totally over,” he told reporters who had surrounded him in a Capitol basement hallway as he headed in to the party’s caucus meeting.

Shortly before Ryan’s press conference, Trump called Washington Post reporter Robert Costa to say they were pulling the bill back from consideration. Costa said the president seemed at ease with the decision and did not blame Ryan for the defeat.

Trump, Ryan and other GOP lawmakers tweaked their initial package in a variety of ways to win over both conservatives and moderates. But every time one change was made to win votes in one camp, it repelled support in another.

The White House on Thursday accepted conservatives’ demands that the legislation strip federal guarantees of essential health benefits in insurance policies. But that was another problem for moderates and Democrats suggested the provision would not survive in the Senate.

Republican moderates in the House — as well as the Senate — objected to the bill’s provisions that would shift Medicaid from an open-ended entitlement to a set amount of funding for states that would also give governors and state lawmakers more flexibility over the program.  Moderates also were concerned that the package’s tax credits would not be generous enough to help older Americans — who could be charged five times more for coverage than their younger counterparts — afford coverage.

The House package also lost the support of key GOP allies, including the Club for Growth and Heritage Action. Physician, patient and hospital groups also opposed it.

It’s not clear what will happen next to the Republican effort to overturn or modify Obamacare. But White House officials told members Thursday that if they couldn’t pass the legislation, the president wanted to turn to other priorities, including tax reform. “The president understands this is it,” Spicer said. “We had this opportunity to — to change the trajectory of health care, to help improve — put a health care system in place and to end the nightmare that Republicans have campaigned on called Obamacare.”

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

Not A Done Deal: Ryan Pulls Back Bill To Replace Obamacare

Despite days of intense negotiations and last-minute concessions to win over wavering GOP conservatives and moderates, House Republican leaders Friday failed to win enough support to pass their plan to partially repeal and replace the Affordable Care Act.

House Speaker Paul Ryan made the announcement at the Capitol after rushing to the White House to meet with President Donald Trump. The decision came after a fluid 24 hours of negotiation among Republican leaders and different factions of the party. The leadership had hoped to have a vote on their bill Thursday but put that off after it was clear they didn’t have enough “yes” votes. Trump issued an ultimatum to House members Thursday night, saying he was done with concessions and they needed to vote Friday to get the legislation moving. But the gambit did not change enough votes to push the bill through the House.

Story is developing. Check back here for more details shortly.

Insurers May Notch Bigger Profits From Fewer Customers In ‘Trumpcare’

The House GOP’s embattled health care bill has plenty of detractors: Democrats, hospitals, the American Medical Association and the House Freedom Caucus all oppose it. But the insurance industry is not on that list — even though it stands to lose millions of customers.

One reason the industry has been hanging back: Insurers’ profits are expected to fatten under the bill.

The House Republicans’ replacement plan would likely attract more younger, healthier consumers to the individual market than the Affordable Care Act did, according to Standard & Poor’s, the corporate credit rating firm. The ACA tilted the opposite way, offering more options for older, sicker Americans whose health care claims eroded insurers’ profits.

“Profitability will likely improve, as the replacement plan can result in an improved risk pool in the individual market,” S&P said in a report on the House leadership’s initial plan.

A vote on the GOP “Trumpcare” bill is expected Friday, but by late Thursday it remained unclear whether there were enough votes to pass it. The Trump administration has said if the measure doesn’t pass Friday, it will abandon the effort to replace Obamacare.

Under the current health law, an insurer is allowed to charge a 64-year-old consumer a premium that’s three times what it charges a 21-year-old. The House bill allows insurers to charge older consumers premiums that are five times higher.

That change would reduce premiums for younger consumers but boost them significantly for people in their 50s and 60s – even with tax credits that increase for older people under the GOP plan.

Not all insurers are enthusiastic about what’s in the House bill. Those that are also mainly in the business of managing Medicaid services to enrollees under contract with states — such as Molina Healthcare — oppose the bill because of the expected sharp reductions in Medicaid if the House measure is enacted.

In a new analysis of the House bill that was released Thursday, the Congressional Budget Office predicted 9 million people would fall off Medicaid rolls by 2020 and 14 million by 2026. Overall, 52 million Americans under 65 would be uninsured by 2026 compared with 28 million that year under current law, the CBO said.

America’s Health Insurance Plans (AHIP), which has expressed concerns about the bill but hasn’t taken a formal position for or against the bill, has said the legislation’s provisions would give short-term relief to insurers that have been mostly losing money since the exchanges started in 2014.

Those include giving states $100 billion over 10 years to start high-risk pools and stabilization funds to help insurers deal with higher-risk customers.

One of the most significant positives for insurers in the GOP bill is the elimination of a tax that all insurers paid under the ACA. The industry paid $8 billion in 2014 and is expected to pay $14.3 billion in 2018. Congress temporarily suspended the fee for this year.

Insurers’ opposition to the tax was one of the main reasons why the insurance industry chose not to support the ACA when it was approved in 2010. However, the insurance industry built support for the law by throwing its weight behind a requirement preventing insurers from refusing coverage to consumers with preexisting conditions in exchange for a mandate that most Americans have health coverage.

Although many conservative Republicans favor ending the individual mandate, the GOP bill as originally proposed would instead require that Americans keep continuous health coverage or pay a 30 percent penalty when they do buy private coverage.

Many of the nation’s largest insurers, such as UnitedHealthcare, Cigna and Aetna, were never large players in the health law’s exchanges or they have pulled out citing steep financial losses. For them, the elimination of the health insurer tax makes the GOP bill look appealing, said Ana Gupte, a health analyst with Leerink, an investment bank. “The GOP bill is a net positive” for those insurers, she said.

Even insurers with many customers on ACA policies now will be better off financially in the GOP bill, Gupte said. “They will make a bigger [profit] margin on a smaller number of people,” she said.

Anthem, a larger player in the Obamacare marketplaces, has said the GOP bill would benefit insurers and individuals by ensuring that remaining insurers stay in the market to provide choices for consumers.

Health insurers’ cautious optimism about the bill contrasts with the rest of the health industry. Lobbying groups representing doctors, hospitals and nurses have objected vehemently to the legislation. AHIP spokeswoman Kristine Grow said the group remains concerned about the long term stability of the Medicaid health plan market because the GOP bill would kill the Medicaid expansion and reduce federal Medicaid funding to states. She also said it’s too early to know how insurers’ 2018 premiums would be affected under the GOP bill.

A big uncertainty for insurers is whether the Trump administration will continue to allow a key program under Obamacare that helps low-income individuals with out-of-pocket health costs. House Republicans suspended a lawsuit that claimed the $7 billion federal funding of the program was illegal.

The program’s future is of concern to Dr. J. Mario Molina, CEO of Molina Healthcare, which has 3 million Medicaid members and nearly 1 million customers on Obamacare exchange plans. The Long Beach, Calif.-based company operates in about a dozen states.

But Molina said his biggest concern is the GOP bill will return the country to the broken individual market system in place before 2014. “The main thing I am worried about is this bill will cause millions of people to lose insurance coverage,” he said.

Regardless of what Congress and the Trump administration decide to do with Medicaid’s federal funding, Molina predicted more states will shift Medicaid recipients into managed care plans to control costs. “In the short term, we will still grow,” he said.

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

A 15-Minute Vinyasa Flow That Eases Neck Pain and Tension

A bad night's sleep, a killer upper-body workout, a long day hunched over your desk—whatever causes your neck pain and tension, you need relief fast. This 15-minute vinyasa flow will help soothe the sore muscles in your neck and around your upper spine. 

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You'll flow through a sequence of seated poses—that's right, you don't even need to stand up for this one. Just sit back, relax, and use your breath to guide you through each stretch and pose for relief. This practice is gentle and calming, making it a perfect choice for when you wake up with a stiff neck or before bed after a stressful day. All you need is a mat; then hit play to get started. 

Looking for more short and effective at-home workouts? Grokker has thousands of routines, so you’ll never get bored. Bonus: For a limited time, Greatist readers get 40 percent off Grokker Premium (just $9 per month) and their first 14 days free. Sign up now!

7 No-Bake Chocolate Desserts You Can Throw Together in 20 Minutes or Less

The next time you have a hankering for chocolate (probably right now), you can make an easy homemade treat without ever turning on the oven. Because, really, who has the patience to preheat when it's a chocolate emergency? This week's featured foodie, Megan Gilmore of Detoxinista, has tons of ideas for no-bake cookies, brownies, crumble bars, and puddings that we're drooling over. If the recipes in her newest cookbook, No Excuses Detox, are anything like these, then we'll be ordering ASAP. After one look at these seven chocolate recipes, you’ll have no excuse not to dive in tonight.

1. Vegan Almond Butter Buckeyes A healthier twist on the popular chocolate-covered peanut butter balls, these naturally sweetened almond butter truffles are cloaked in a quick 3-ingredient homemade chocolate shell. Feel free to use sunflower butter as a nut-free alternative too.  2. Vegan Mini Peanut Butter Cups These bite-size candies call for just five ingredients and are lower in sugar than the store-bought variety. If you have more time, Meghan suggests stuffing them into these Peanut Butter Temptation Cookies for an ultra-decadent treat—we're definitely doing that. 3. No-Bake Brownie Bites Calling for just four main ingredients, these chocolate bites taste like the rich brownies from the bakery next door. They're ready in half the time it would take to bake a batch and are sweetened with fruit... and that's it. 4. Vegan Cookie Dough "Ice Cream" You only need about 15 minutes and a mini-food chopper to make this quick and easy dairy-free ice cream. It's almost entirely sweetened with fruit, depending on whether you choose to add some mini dark chocolate chips or not (and we highly recommend that you do).  5. No-Bake Chocolate Pecan Crumble Bars Buttery pecans and sweet dates? Dream. And in these bars it's a double dream because they make up the crust and the crumbly top, with a layer of homemade chocolate in-between. These bars only take about 15 minutes of prep work, but you will need to let them set in your freezer for an hour or two before serving for best texture.  6. Creamy Chocolate Chia Pudding Most chia puddings have a tapioca-like texture, but when you blend it, the outcome is super-thick, smooth, and creamy. We'll take two for breakfast, thanks. 7. Easy Dark Chocolate Avocado Truffles If you needed one more reason to worship the avocado, here it is: These truffles get their creaminess from a ripe avocado, not heavy cream. And all you’ll taste is the chocolate.

You can find Megan on Facebook, Pinterest, Instagram, and Detoxinista.com. For exclusive recipes and meal plans, check out her cookbooks, Everyday Detox and the latest, No Excuses Detox, where she shares crowd-pleasing healthy recipes that are fast and affordable, using ingredients you probably already have in your pantry. (Available on amazon.com for $10.70.)

Popular Guarantee For Young Adults’ Coverage May Be Health Law’s Achilles’ Heel

The Affordable Care Act struck a popular chord by allowing adult children to obtain health coverage through a parent’s plan until their 26th birthday.

Now, seeking broad support for their efforts to repeal and replace the ACA, House Republicans have kept that guarantee intact. But it’s not clear whether that provision will be successful or a destabilizing force in the insurance marketplace.

The policy has proven to be a double-edged sword for the ACA’s online health exchanges because it has funneled young, healthy customers away from the overall marketplace “risk pool.” Insurers need those customers to balance out the large numbers of enrollees with chronic illnesses who drive up insurers’ costs — and ultimately contribute to higher marketplace premiums.

Joseph Antos, a health economist with the American Enterprise Institute, a Washington, D.C.-based conservative think tank, said the ability for young adults to stay on family plans represents a “critical mistake” within the health law, cutting off insurers from a large, healthy demographic that likely would be able to afford a health care plan.

“This is essentially an ideal group for an insurance company,” he said. “They’re not going to use many services, and they’re going to pay their bills.”

The young-adult provision went into effect in September 2010 and families put it to use quickly, with many young adults leaving their own insurance plans. A report published by the Centers for Disease Control and Prevention in 2013 found the percentage of adults ages 19 to 25 with personal plans fell from nearly 41 percent in 2010 to just over 27 percent in 2012, while the ratio of those covered through a family member’s plan rose by 14 percentage points.

And the Department of Health and Human Services said last year that final 2016 marketplace enrollment numbers showed more than 6 million people ages 19 to 25 gained insurance through the health law, including 2.3 million who went onto their family health plan between September 2010 and when online marketplaces began operating in 2014.

Cara Kelly, a vice president of the health care consulting firm Avalere Health, said the provision’s effect must be understood in the context of the law’s implementation. Affordability and the selection of plans available in the marketplace also could have influenced the decision among young adults to buy or shirk insurance, Kelly said. Even if the provision had not been included in the law, she said, one can’t assume that the young adults would have signed up for coverage.

A little more than a quarter of marketplace customers in 2016 were adults ages 18 to 34, according to data from the Department of Health and Human Services. But federal officials and insurers had hoped for higher rates, noting that the group made up about 40 percent of the potential market.

Public support for the young-adult provision makes it difficult to take away. A survey conducted by the Kaiser Family Foundation in December 2016 found that 8 in 10 Republicans and 9 in 10 Democrats favored the benefit. (Kaiser Health News is an editorially independent program of the foundation.)

[caption id="attachment_713549" align="alignright" width="443"] The young-adult provision went into effect in September 2010 and families put it to use quickly, with many young adults leaving their own insurance plans. (Centers for Disease Control and Prevention)[/caption]

“It has been extremely popular,” said Al Redmer Jr., the Maryland insurance commissioner and chairman of the health insurance and managed care committee within the National Association of Insurance Commissioners. “So with that being the case, I don’t know if politically there’s an appetite to unwind it.”

Republicans have opted for different measures than the ACA to attract increased numbers of healthy, young customers and make the risk pools vibrant. To keep prices lower for these customers, the bill allows insurers to charge older people up to five times more than young adults. Under the ACA, that difference is 3-to-1, and Republicans say that made prices too expensive for younger customers.

It would also replace the health law’s individual mandate — the requirement that almost everyone have health insurance or face a penalty — with a 30 percent surcharge on their premium for late enrollment or allowing your insurance to lapse for more than 63 days within a year.

The overall effect, according to an analysis conducted by the Congressional Budget Office, would be a more stable market with a larger number of healthy enrollees. The report also estimated the bill could result in 24 million more people being uninsured.

But the bill also has disincentives for those young people. To help pay for premiums, low-income people will get tax credits based on age and household income. Older people would get $4,000 per year, twice as much as younger customers.

Insurers have reacted cautiously. The insurer Blue Cross Blue Shield Association released a statement this month expressing its support for increasing affordability for younger enrollees. But it also raised concerns about the Republicans’ tax credit proposal. A benefit based on age alone “does not give healthy people enough incentive to stay in the market, especially in the absence of an individual mandate.”

The insurance trade group America’s Health Insurance Plans sent a letter to House Republican committee chairmen voicing support for the 5-to-1 age-band rating and tax credits based on age.

“We have stated previously that there is no question that younger adults are under-represented in the individual market,” the letter said. “Recalibrating and reforming the way in which the premium assistance is structured will encourage younger Americans to get covered.”

KHN reporter Mary Agnes Carey contributed to this article.

Late Move To Dump ‘Essential’ Benefits Could Strand Chronically Ill

A last-minute attempt by conservative Republicans to dump standards for health benefits in plans sold to individuals would probably lower the average consumer’s upfront insurance costs, such as premiums and deductibles, said experts on both sides of the debate to repeal and replace the Affordable Care Act.

But, they add, it will likely also induce insurers to offer much skimpier plans, potentially excluding the gravely ill, and putting consumers at greater financial risk if they need care.

For example, a woman who had elected not to have maternity coverage could face financial ruin from an unintended pregnancy. A healthy young man who didn’t buy drug coverage could be bankrupted if diagnosed with cancer requiring expensive prescription medicine. Someone needing emergency treatment at a non-network hospital might not be covered.

What might be desirable for business would leave patients vulnerable.

“What you don’t want if you’re an insurer is only sick people buying whatever product you have,” said Christopher Koller, president of the Milbank Memorial Fund and a former Rhode Island insurance commissioner. “So the way to get healthy people is to offer cheaper products designed for the healthy people.”

The proposed change could give carriers wide room to do that by eliminating or shrinking “essential health benefits” including hospitalization, prescription drugs, mental health treatment and lab services from plan requirements — especially if state regulators don’t step in to fill the void, analysts said.

The Affordable Care Act requires companies selling coverage to individuals and families through online marketplaces to offer 10 essential benefits, which also include maternity, wellness and preventive services — plus emergency room treatment at all hospitals. Small-group plans offered by many small employers also must carry such benefits.

Conservative House Republicans want to exclude the rule from any replacement, arguing it drives up cost and stifles consumer choice.

On Thursday, President Donald Trump agreed after meeting with members of the conservative Freedom Caucus to leave it out of the measure under consideration, said White House Press Secretary Sean Spicer. “Part of the reason that premiums have spiked out of control is because under Obamacare, there were these mandated services that had to be included,” Spicer told reporters.

Pushed by Trump, House Republican leaders agreed late Thursday to a Friday vote on the bill but were still trying to line up support. “Tomorrow we will show the American people that we will repeal and replace this broken law because it’s collapsing and it’s failing families,” said House Speaker Paul Ryan (R-Wis.). “And tomorrow we’re proceeding.” When asked if he had the votes, Ryan didn’t answer and walked briskly away from the press corps.

But axing essential benefits could bring back the pre-ACA days when insurers avoided expensive patients by excluding services they needed, said Gary Claxton, a vice president and insurance expert at the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

“They’re not going to offer benefits that attract people with chronic illness if they can help it,”said Claxton, whose collection of old insurance policies shows what the market looked like before.

One Aetna plan didn’t cover most mental health or addiction services — important to moderate Republicans as well as Democrats concerned about fighting the opioid crisis. Another Aetna plan didn’t cover any mental health treatment. A HealthNet plan didn’t cover outpatient rehabilitative services.

Before the ACA most individual plans didn’t include maternity coverage, either.

The House replacement bill could make individual coverage for the chronically ill even more scarce than a few years ago because it retains an ACA rule that forces plans to accept members with preexisting illness, analysts said.

Before President Barack Obama’s health overhaul, insurers could reject sick applicants or charge them higher premiums.

Lacking that ability under a Republican law but newly able to shrink benefits, insurers might be more tempted than ever to avoid covering expensive conditions. That way the sickest consumers wouldn’t even bother to apply.

“You could see even worse holes in the insurance package” than before the ACA, said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University. “If we’re going into a world where a carrier is going to have to accept all comers and they can’t charge them based on their health status, the benefit design becomes a much bigger deal” in how insurers keep the sick out of their plans, she said.

Michael Cannon, an analyst at the libertarian Cato Institute and a longtime Obamacare opponent, also believes dumping essential benefits while forcing insurers to accept all applicants at one “community” price would weaken coverage for chronically ill people.

“Getting rid of the essential health benefits in a community-rated market would cause coverage for the sick to get even worse than it is under current law,” he said. Republicans “are shooting themselves in the foot if they the offer this proposal.”

Cannon favors full repeal of the ACA, allowing insurers to charge higher premiums for more expensive patients and helping consumers pay for plans with tax-favored health savings accounts.

In an absence of federal requirements for benefits, existing state standards would become more important. Some states might move to upgrade required benefits in line with the ACA rules but others probably won’t, according to analysts.

“You’re going to have a lot of insurers in states trying to understand what existing laws they have in place,” Koller said. “It’s going to be really critical to see how quickly the states react. There are going to be some states that will not.”

Mary Agnes Carey and Phil Galewitz contributed to this story.

Break Out of Your Food Rut!

What's for dinner? What are you eating for breakfast or lunch tomorrow? If you aren't feeling excited about your meals, or if your kids are complaining about eating chicken again, you may be in a food rut.   It happens easily; between work obligations, social plans, and kids' soccer practices, we tend to fall back on easy-to-prepare staple meals that don’t require much thought or effort. And for some of us, cooking doesn’t come easily or isn’t a pleasure, so we rely on a handful of recipes we can confidently prepare.   While it's wonderful to have a few go-to meals you can rely on in a pinch, it can get old when you rely on the same meals too often. And that lack of excitement about what's on your plate could lead you to reach for additional snacks or sweets to bring more pleasure back to your eating—which can be a problem if you're trying to manage your weight or eat healthier.   We recently asked SparkPeople members if they were stuck in a diet rut, and we were surprised by how many people replied. Member CHOUBROU summed it up this way: ''The food rut is my biggest problem! I fall into it because eating the same go-to meals is convenient and easy. But eventually I get tired of eating the same thing, and that leads me to the temptation of eating out more, eating more frozen/processed meals, etc.''   SparkPeople member KALENSMOMMY5 asked for help: ''One of the main reasons I fall off the healthy eating wagon is that I get caught in a major food rut! As I am a full-time working single mom to a toddler, I have very limited time to cook, so I end up buying the same grab-and-go foods week after week. The unhealthy choices start to look more and more attractive as I get more bored with my standard foods. Help would be much appreciated!''   Lots of folks told us they’ve hit the wall, cooking-wise. What’s more, they shared great advice on how you can break boring food habits, no matter what causes them.   5 Signs You're Stuck in a Food Rut (and What to Do about It)   Sign #1: You Don’t Enjoy Cooking For many folks, getting dinner on the table is a chore, not a pleasure. If you don’t love to cook, or you’re not confident in your culinary skills, then it's normal to feel like you're in a food rut for awhile—at least until you develop a few basic meals that you can prepare quickly and easily. Here’s how:

  • First, think about what you enjoy eating. Sandwiches? Burritos? Breakfast for dinner? Salads? Consider how you can make those into healthy dinner options.  
  • Settle on three to five things you like, and find simple recipes for those meals. SparkRecipes is a great resource for quick and healthy meal ideas.  
  • Get comfortable with the basics. Once you’ve mastered an essential technique like sautéing boneless chicken breasts, then you can move on to experiment with different sauces or add-ins to change things up over time and prevent yourself from getting bored.  
  • Accept that you don’t love to cook, but don’t let that be your excuse for not eating healthy. If you master a few basic recipes, you’ll gain confidence—and you’ll be making a commitment to yourself.
Sign #2: You’re On Auto-Pilot Even accomplished home cooks tend to get stuck in a rut preparing the same go-to dinners over and over. Katie, a mother of two, posted: ''[My son] calls me on my food ruts—I know I've got problems when my garbage disposal of a kid complains about what I'm cooking.''   Like many folks who commented on our question about food habits, Katie says she refers to cooking magazines (her favorite is Food and Wine) for inspiration when she’s stuck in a routine. Cooking Light magazine and the books ''Cook This, Not That'' by David Zinczenko and Matt Goulding, and ''Fast Food My Way'' by Chef Jacques Pepin were also recommended as great resources for quick and healthy meals.   David posted about different ways to find culinary inspiration: ''I realize [I’m in a food rut] when I’m on auto-pilot preparing a meal that usually gives me joy to cook. I break it up by shopping somewhere new for groceries, or getting a new cooking gadget, or sharpening my knives or getting a new spice.''   A simple strategy for busting out of the auto-pilot cooking rut is to find alternate ways to prepare those go-to meals—in particular, look to different ethnic cuisines for interesting takes on your standards. If spaghetti with meat sauce is in your repertoire, try linguine with spicy shrimp sauce instead. Not feeling that leftover chicken? Turn it into something new, like a tostada. Sometimes simply swapping a few ingredients within a go-to recipe can give you a whole new flavor and make your meals interesting again. Same with sides: If you're always steaming broccoli or brown rice, experiment with other healthy veggies or whole grains such as whole-wheat couscous, millet or quinoa instead.   Sign #3: You Always Eat the Same Meals This food rut often shows up at the start of the day, when we’re so busy getting out the door that we neglect a healthy breakfast, or we choose convenience foods over healthy ones. SparkPeople member LINDSAYHENNIGAN commented that she found herself eating high-fiber breakfast cereal every day: ''I got too focused on how much fiber they added, and failed to notice the 40 grams of sugar I was consuming each morning. My trainer caught it, and switched me over to bread with 2 or less grams of sugar with peanut butter, and I feel so much better.''   SparkPeople member FLUTTEROFSTARS, a vegetarian, shared a bunch of great ideas she enjoys to start her day: ''I’m fighting to get out of my food rut! I’ve been 'Sparking' for two months now, and have come up with several winning mini-meals.'' Some of her favorites include:
  • Salad with Morningstar veggie crumbles and low-fat cheddar cheese
  • Omelets with frozen vegetable blend
  • Greek yogurt with strawberries and flaxseed
  • The ''one-minute microwave muffin'' recipes for breakfast sandwiches from SparkRecipes
We all go through busy periods in our lives—a hectic few weeks at work, an extra-busy sports season—and getting a healthy dinner on the table every evening is even more challenging. Creating a weekly meal plan and then shopping for all the ingredients you’ll need helps avoid the food rut. When you know in the morning what you’re making for dinner that night, you can avoid grabbing quick and not-so-healthy items on that emergency trip to the grocery.  And planning dinners that can be repurposed into lunches avoids brown-bag boredom.   Sign #4: You’re Bored with Brown Bagging We’ll congratulate you for committing to bringing a healthy lunch instead of heading to the nearest fast food joint. But the contents of your brown bag need an overhaul if you’re stuck in the PB&J or turkey sandwich routine day in and day out.   Turning dinner into lunch is a great way to vary your midday meal, especially if you plan ahead and prepare extra food in the evening for the next day’s (or week’s) lunchbox. A dinner of grilled steak and veggies can become a lunchtime salad, and a pasta supper easily transforms into a chilled pasta salad a day later.   SparkPeople member FELIFISH26 posted: ''I usually eat the same boring thing for lunch (half a turkey sandwich on sandwich thin bread, cottage cheese, low-fat chips). BLAH, right?! After awhile your taste buds start to get used to it all, and I could probably be eating cardboard and not know the difference!'' She solved her lunch dilemma by combining some cooked chicken from dinner the night before with fresh pico de gallo that she made with chopped tomato, onion and cilantro. New lunch idea: chicken tacos.   Sign #5: You’re Stuck on ''Diet-Safe'' Foods Several SparkPeople members commented that their commitment to weight loss means they have a limited number of meal options that meet their calorie limits. Member STACYD16 wrote, ''I do believe that I'm in a food rut. I eat the same things daily because I know their caloric contents. I do have a cheat day about once a week that I really enjoy—and I thought that would throw me off, but it has really helped. I realized my issue is more portion control vs. the actual foods that I eat.''   While eating within a calorie range can be a challenge, portion control can help. You can also search for specific recipes within a certain calorie range by using the Advanced Search on SparkRecipes.com. So if you want slow-cooker dinners that contain fewer than 400 calories, simply edit your search options and voila! You'll be surprised just how many delicious and easy meals you can find within your calorie range for any meal.   When All Else Fails: Embrace the Rut Here’s one final strategy for breaking out of your food rut—know that you’ll get into one. Steve posted about exactly that: ''Another thing I'll do is the mid-week ‘king's food’ omelet—where, no matter what, I'll cook an omelet using the leftovers of previous meals. This does two things: It creates interesting flavors with combos I’d normally never think of, and it motivates me to cook good stuff early in the week because it's potential omelet fodder.''   Just as you can't expect perfection when it comes to eating within your calorie range, losing two pounds per week, or exercising as much as you'd like, you can't expect to be perfect in the kitchen, either—or to love every bite you eat. Accept that we all go through ruts with our food. But instead of allowing it to throw you off track, use it as a sign to change things up and find creative ways to make your food fun and delicious again. And remember, this (food rut) too, shall pass!   Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1759

8 Tips for Deciphering Diet Claims

Though food is supposed to be one of life's simple pleasures, few things cause more angst and confusion. It's no wonder why. We're constantly being told which foods we should eat to be healthy, which diets we should follow to be skinny, which preparation methods we should use to be safe, and which chemicals and contaminants in food we should shun to avoid illness. It's enough to give anyone indigestion. If you're confused about what to believe, you've come to the right place. In "Coffee Is Good for You," I'll give you the bottom line on an array of popular diet and nutrition claims in a quick, easily digestible way. Research about diet and health rarely yields the equivalent of DNA evidence, which provides incontrovertible proof. All types of studies come with caveats. However, if interpreted properly, a body of research can allow us to make sound judgments about how believable a claim is. Trying to make sense of the seemingly endless stream of food and nutrition claims can be overwhelming. Remembering the following 8 rules will make the task easier and allow you to stay focused on what’s really important:

  1. Don’t fixate on particular foods. Be wary of lists of miraculous “superfoods” you must eat or “toxic” foods you should never touch. Rather than worrying about squeezing one food or another into your diet, focus on your overall eating patterns, which should include plenty of vegetables, fruits, whole grains, fish, legumes, and good fats, and limited amounts of refined carbohydrates, junk food, red meat, and trans fats.  
  2. Look beyond narrow categories like carbs and calories. Many diet books and seals of approval on foods emphasize one or two factors, such as the calorie or carbohydrate count, while giving short shrift to other important things, like fiber, sodium, or trans fat. The fact that a hamburger is lower in calories than a salad doesn’t necessarily make it a better option. Likewise, just because fruit punch or cereal has added vitamins doesn’t mean it’s healthful. What’s important is the overall nutritional profile. You can get this from comprehensive food- scoring systems such as NuVal, which ranks the healthfulness of foods based on more than 30 factors.  
  3. Forget about fad diets. A plethora of weight- loss plans promise to melt away pounds quickly and easily. But in the long run, they rarely work. About 95 percent of dieters eventually regain lost weight. Instead of searching for the secret to skinniness, which doesn’t exist, try to eat more healthfully and be mindful of how much you’re consuming. Combined with exercise, this approach can prevent weight gain and, over time, lead to weight loss. And unlike dieting, it’s something you can stick with long term.  
  4. Recognize the limits of vitamin pills. While vitamin and mineral supplements can help make up for deficiencies of nutrients, they generally don’t live up to their billing when it comes to preventing disease, boosting energy, or improving your overall health. Supplements pack far less nutritional punch than food, which contains multiple nutrients that interact with one another and with other foods in a variety of complex ways. As a result, vitamin pills can’t compensate for an unhealthful diet. And they can cause harm if you take too much of certain nutrients.  
  5. Ignore health claims on food packages and in ads. A few such claims, such as those related to sodium and high blood pressure, are officially approved by the FDA, but most aren’t. They fall under a loophole that allows companies to use sneaky language like “helps maintain healthy cholesterol levels” or “helps support a healthy immune system.” Because these phrases don’t explicitly say that the food prevents or treats disease— even though that’s what any normal person would infer—manufacturers don’t have to provide any evidence. What’s more, there are no strict definitions for frequently used terms such as all natural, low sugar, and made with whole grains or real fruit. Because it’s virtually impossible to distinguish between legitimate and misleading claims by manufacturers, the best approach is to disregard them all and get your information from the Nutrition Facts panel on the package.  
  6. Verify emails before forwarding them. The vast majority of emails about food and nutrition are half truths or outright hoaxes. If someone forwards you an email claiming, for example, that canola oil is toxic or that asparagus cures cancer, assume it’s not true, no matter how scientific it sounds. Check it out with a reputable source like Snopes. com or Urbanlegends. about. com. Forwarding unconfirmed claims only adds to the hype, misinformation, and confusion.  
  7. Don’t be influenced by just one study. When you encounter news reports about the latest study, don’t jump to conclusions based on that alone. Remember that it’s just one piece of a puzzle. What matters is the big picture— what scientists call the totality of the evidence. For a credible overview of the science, check out online sources such as the Nutrition Source from Harvard School of Public Health, or newsletters such as Nutrition Action Healthletter, the Tufts Health & Nutrition Letter, and the Berkeley Wellness Letter. Or go to www. pubmed. gov and look up the research yourself.  
  8. Enjoy eating! As I said at the beginning of this book, all the admonitions about which foods we should and shouldn’t consume can make eating a stressful chore. But it doesn’t have to be that way. Using science as your guide, focus on the claims with the greatest credibility and relevance, and tune out the rest. That way, you’ll feel less overwhelmed. While following sound nutrition advice is important for good health, it need not spoil your dinner. Bon appétit!
   Adapted with permission from "Coffee is Good for You" by Robert J. Davis, PhD, by arrangement with Perigee, a member of Penguin Group (USA) Inc., Copyright (c) 2012 by Robert J. Davis, PhD, MPH. Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1725

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