March, 2011 browsing by month


What’s a “Health Care Exchange” and Why Should You Care?

Wednesday, March 30th, 2011

One of the biggest changes in health care that comes as a result of last year’s vote to institute health care reform, hasn’t begun to take shape yet. This is the inception of the “Health Care Exchange” marketplaces – due to take effect by January 2014. And once the health care exchanges get rolling, we’ll finally see the full impact of health care reform.

But what is a Health Care Exchange, exactly, and how will it affect you? Think of it as a health insurance “store,” where individuals and small businesses get to choose the best policies for their needs. Only those insurers that meet certain requirements will be allowed to sell their policies in this “store.” For example, each insurer will have to offer plans with certain “essential benefits” and will not be able to deny coverage to those with pre-existing conditions, nor will they be able to exclude coverage for benefits that such people need. Most states will run their own Health Care Exchanges but some might opt to partner with neighboring states, while others might let the federal government run their exchanges.

A big question everyone wants answered: will insurance sold on the Health Care Exchanges be affordable? Here is where health care reform shows its muscle. Insurers, under the health care law, must pay out from 80 to 85 percent of premiums for health care costs. And, according to this article in the Washington Post:

People who make less than 133 percent of the federal poverty level, $14,484 this year, will qualify for Medicaid in all states, under the law. Above that, sliding-scale subsidies for private insurance on the exchanges will be available for residents who make up to 400 percent of the poverty level, about $43,560 this year. Most people will be required to have coverage of some sort beginning in 2014.

But probably the best cost controls come from the transparency of the Health Care Exchange system, because consumers and small businesses will be able compare one policy to another in terms of cost, coverage, deductibles, and exclusions, before they buy. And maybe – just maybe – that will bring health insurance costs in the U.S. more in line with other developed countries where people typically get much better coverage at much lower cost.

– Yvonne S. Thornton, MD, MPH

Lioness Mom, Yvonne Thornton meets Tiger Mother, Amy Chua

Friday, March 11th, 2011

Because of my lofty ambitions for my children, which I wrote about at length in Something to Prove: A Daughter’s Journey to Fulfill a Father’s Legacy, I’ve been compared often lately to Amy Chua, author of Battle Hymn of the Tiger Mother. She and I were both guests on Minnesota Public Radio’s Midmorning show last week.

You can hear the program here.

– Yvonne S. Thornton, MD, MPH

Moms-to-be: A New Warning Against Smoking

Monday, March 7th, 2011

A study by the CDC, appearing in the journal Pediatrics shows, once again, that smoking cigarettes during pregnancy (with its nicotine and other toxic substances) is a health risk to your baby. Reuters Health reports:

…women who smoked early in pregnancy were 30 percent more likely to give birth to babies with obstructions in the flow of blood from the heart to the lungs, and nearly 40 percent more likely to have babies with openings in the upper chambers of their hearts.

We’ve known for many years of the dangers of smoking during pregnancy, and this study just adds to that knowledge. Mothers-to-be take note: what goes into your body affects your baby—possibly for a lifetime.

– Yvonne S. Thornton, MD, MPH

The Latest News From the CDC on Birth Defect Risks

Saturday, March 5th, 2011

In a report published in the American Journal of Obstetrics and Gynecology, the Centers for Disease Control (CDC) [] warned against using prescription opiate-based painkillers such as codeine, hydrocodone or oxycodone (brand names include Vicodin and Oxycontin) during pregnancy.

According to an article about the CDC report:

In the study of data from 10 states, the CDC researchers found that 2 percent to 3 percent of mothers interviewed received prescription opioid pain killers, or analgesics, just before they got pregnant or early in their pregnancy. Any illicit use of painkillers was not assessed.

For those women, the risk of having a baby with hypoplastic left heart syndrome — a critical heart defect — was about double that of women who took no opioid drugs.

Risks of other birth defects, including spina bifida (a type of neural tube defect), hydrocephaly (build up of fluid in the brain), congenital glaucoma (eye defect), and gastroschisis (a defect of the abdominal wall), also somewhat increased among babies whose mothers took these drugs either shortly before or during pregnancy.

I have concerns about the generalization of both articles, but the conclusions may be valid. Taking a drug before you’re pregnant, or up to 17 days after conception, is unlikely to cause birth defects. It will either cause a miscarriage or will have no effect. But because most women don’t know precisely when they conceived, it’s best to avoid taking drugs at any time during pregnancy.

The greatest risk to a developing baby from a pregnant mother taking potentially toxic drugs occurs between 17 days post-conception to 12 weeks (end of the first trimester).

You’ve probably heard of Thalidomide, a sedative given in the 1950s to pregnant women in their first trimester. It dramatically illustrated the risks to a fetus’s development from drug effects during the critical first weeks. Thalidomide given early in pregnancy stunted the development of babies’ arms, legs, hands and feet, and caused other limb deformities.

If you’re pregnant, or planning to be, you should also be aware that most drugs, whether prescription or over-the-counter can have unknown effects on a growing fetus. The bottom line is: Every drug is, in some sense, a poison. Don’t consider any drug safe in pregnancy unless prescribed by someone who knows its toxicity as well as the risks and benefits of the drug.

– Yvonne S. Thornton, MD, MPH