In another one of my blogs, I outlined the reasons why you should quit tanning once and for all. I mainly focused on the health risks associated with tanning, including skin cancer and premature aging. One important new tax to know about is the tan tax, a tax on indoor tanning services that began on July 1 2010.

A tax on indoor tanning will help pay for healthcare reform

To fund the 2010 Affordable Care act, the federal government will now levy a 10 percent tax on indoor tanning, which started on July 1^st.  Spray tans and other sunless tanning products will not be taxed under the new legislation.  The tanning tax is expected to generate 2.7 billion dollars towards health care reform.  Dermatologists and other advocates hope that the tanning tax will dissuade people from baking their skin in indoor tanning beds.

Why tax tanning?

To begin with, countless dermatological studies have shown that tanning has a negative impact on the body. Exposure to UV rays damages the skin’s DNA, leaving people more than three times more likely to develop skin cancers like melanoma.  Although many skin cancers can be treatable, melanoma is the most deadly skin cancer—as well as the most common type of skin cancer found in young people. Indoor tanning beds can also contribute to premature aging of the skin, causing younger people to develop wrinkly or leathery looking skin. A young survivor of skin cancer who tanned in his youth even wants to ban tanning for minors because of health risks.

Initially, cosmetic surgery procedures were the victims of the tax—known as the “Botax” for the popular Botox procedure, until dermatologists successfully lobbied Congress to hit indoor tanning beds instead.

Still, tanning businesses fear that the new tax will put a damper on their fun in the sun. Before the 10% tax went into effect, many small businesses expressed their concern over the tax’s impact on business. Although tanning packages purchased at tanning salons will be exposed to the tax, health clubs that also feature tanning beds are exempt from the new legislation. One famous tanning salon patron, the Jersey Shore’s majestically orange Snooki, claimed that she would stop using tanning beds for good because of the tax, and use spray tan services instead. Other tanners said that the tax wouldn’t affect their tanning habits.

Other businesses claim that they have already noticed a drop off in sales. According to an article in the Washington Post, one tanning salon in Arlington, Virginia noticed a 20 to 30 percent drop off in business since the recession, and anticipated worse since the tanning tax went into effect July.  Then again, it is July, the height of beach season, when indoor fake n’ bake tanning really isn’t necessary, which could factor into that sales decline.

While time will tell how hard the tax will hit the tanning industry, I feel tanning salons should not be the only establishments subject to the tax.  By exempting fitness centers from taxation, the government is really squeezing the tanning industry. Still, the tax may serve as an additional incentive—including health—for people to stop tanning once and for all.

When I think of the emergency room, I think of the crowded waiting area, chock full of people who have been waiting a long time to see a doctor.  The Center for Disease Control confirms that image. Studies have shown that the average wait to receive care is around one hour. A 2006 report by Press Ganey Associates found that the average stay in an American emergency room clocks in at around 3.7 hours. Patients filled out satisfaction surveys, and Arizona clocked in with the highest average wait time at 297.3 minutes—close to five hours!  Iowa led the way with a wait time of 138.3 minutes, a little over two hours worth of time spent in the hard plastic waiting room chairs.

Healthcare providers working to reduce Emergency Room waits

Some feel that the health care reforms will put the squeeze on emergency rooms. After Massachusetts implemented universal health care, emergency rooms reported a boost in people. Even though the health insurance would theoretically give them more access to preventative care, the primary care physician shortage may actually make it more difficult to seek preventative services, consequently making ER care ever more critical.

It’s no surprise that hospitals throughout the United States are working to increase patient satisfaction by decreasing hospital wait time. According to the Baltimore Sun, in 2006, 120 million patients went to an emergency room, a sizeable increase from ten years earlier. More and more people are using the ER to receive care. By using innovative, inexpensive new technology, emergency rooms are cutting down unnecessary services.  Hospitals in some states use texts and emails to communicate with patients, marketing their services.

A recent article in the Baltimore Sun details the efforts of area emergency rooms.  At St. Joseph Medical Center in Towson, the hospital advertises its emergency room wait time online. This initiative has raised patient satisfaction, increasing the likelihood that patients will choose St. Joseph’s. St. Joseph’s cuts out unnecessary, bulky procedures to streamline care.  At the University of Maryland Medical Center, staff moves patients in need of urgent care to beds instead of housing them in the ER.  Many other Maryland hospitals have added staff to deal with emergencies.

In Arizona, the state that the third longest wait time in 2009, hospitals are also marketing their wares. Gilbert Hospital in Phoenix ran an ad touting its ER services, highlighting the fact that most patients saw a doctor in 31 minutes or less. Other area hospitals used billboards and other media to promote speedy service. By marketing their superior service, hospitals can increase their business, unless their actions don’t back up their words.

All in all, the fact that emergency rooms are working to become more efficient is promising.  Ultimately, however, I feel that increased ER waiting times are a symptom of the primary care physician shortage. On top of all the slimming and trimming of ER procedures, emphasizing preventative care is crucial to reducing ER wait times.  Building a strong supply of primary care physicians can increase access to preventative care as more and more people are insured.

Medical residencies are notorious for their excruciatingly long shifts.  Doctors fresh out of medical schools use their residencies to gain on the job experience in their desired specialty. Although residencies allow these young doctors to develop expertise, the long work hours can take a toll on their minds and bodies. Residents practice under the supervision of licensed doctors and continue their training as physicians.

In the past, a medical resident could expect to work more than 100 hours a week, with minimal rest in between. Things changed in 2003, when the Accreditation Council for Graduate Medical Education (also known as ACGME), cut down the hours to 80 weekly, although this ruling was not strictly enforced. Still, many shifts can last over a day, up to 30 hours with limited time to sleep.

A new proposal set by ACGME will cut down on mistakes and ensure that patients are safe.   Maximum shift lengths would be reduced hopefully reduce harmful medical from 24 hours to 16 hours for first year residents and to 24 hours for all other physicians. Additionally, attending physicians would be required to make patients aware that they are under the charge of a resident.  The new guidelines will require attending physicians to supervise residents more closely in an effort to improve patient safety. Still, these regulations would only affect first year residents. All other physicians would limited to 24-hour shifts.

Studies have shown that sleep-deprived residents are more prone to making medical mistakes.  A Mayo Clinic study revealed that fatigued, distressed medical residents were more likely to make preventable medical mistakes. Yet another study found that residents were three times as likely to say that they’d made an error during months when they worked one 24 hour long shift.  In 2004, a report discovered that medical residents who worked all night shifts were ultimately accountable for over half of medical errors.

Overworked Medical Residents May Be Catching a Break

Ultimately, some medical mistakes prove fatal. One famous medical malpractice case is that of Libby Zion, an 18 year old college student who died when her overworked, fatigued medical residents prescribed her medication that reacted dangerously with her antidepressants.

Grueling shifts can compromise the health of the doctors themselves. Dr. Shannon Gulliver recently wrote a piece for the New York Times in which she detailed her own weakened immune system, a result of the long hours and high stress of her position. She developed esophagitis, while her colleagues themselves developed shingles, fungal infections, C. difficile diarrhea, and more.

While education is undoubtedly a priority during residency, maintaining the health of both doctors and patients is equally important.  As long as these regulations can cut down life threatening mistakes, I feel that cutting back these hours can be a good thing. Medical residents will still be able to gain the experience they need to practice, and after they complete their first year of residency, young doctors will only be restricted to 24 hour shifts. Ultimately, these guidelines will improve quality of care for patients and better health for doctors and patients alike.

Medical experts have developed a new morning after pill that claims to be better than any other emergency contraceptive pill.  It is called ellaOne.  The attraction: it works for 5 days! You can take the pill for up to five days after unprotected sex and it will work as well as if you took it the morning after.  Its leading competitor, Plan B, only works for up to 3 days after unprotected sex.  This could be the answer to many unwanted pregnancies.

Will EllaOne Be Available in the US?

However, as expected, it raises the ongoing abortion debate.  This new pill, ellaOne, delays ovulation and therefore inhibits conception.  It does so by preventing the progesterone hormone, a hormone that causes females to ovulate, from being released in the female body.  Conversely, those who are on the pro-life side of the debate claim that it is an abortion pill.  They believe that the pill does not prevent this hormone from being released.  Rather, the fact that it works for five days leads them to believe that it stops the fertilized egg from being implanted in the female’s uterus; therefore killing the fertilized egg.  This being the case, then they consider it an abortion.  If the pill was used the morning after, fertilization may not have taken place.  But, by the fifth day fertilization has taken place.  Nevertheless, some assert that the pill does both: it delays ovulation and prevents the fertilized egg from implanting in the uterus.  So the question is: how does it really work?

This debate has not stopped the pill from being released.  Medical experts find that there are more benefits to it than drawbacks.  No major side effects of the pill on women’s health have been found.  If you take the EllaOne Pill within this five day window, there is only a 1.8% chance of you becoming pregnant.  Whereas, with Plan B you have a 2.6% chance of becoming pregnant.

EllaOne is not yet available in the US.  There was a recent assembly in the US where the Federal advisory panel of medical experts met to discuss the potential sale of ellaOne in the US.  These 11 experts unanimously voted in approval of the emergency contraceptive pill.  Now, the FDA will take this vote into consideration as they decide whether or not to allow the sale of ellaOne in the US.  If the FDA approves the pill, it will be available in the US by prescription only; not over the counter.  However, you will need to check with your health insurance provider to see if this contraceptive pill is covered by your insurance plan.  This final decision by the FDA could take up to several months.  EllaOne is currently sold in France (where it originated) and Great Britain.

This morning, President Obama spoke to the press about the Gulf Oil Spill. The BP Oil Spill in the Gulf Coast has given us little predictability as to what the future holds for this catastrophic event.  This is the worst oil spill in US history; therefore raising many questions that have never been answered before.  With tar balls now showing up on the beaches in Galveston County Texas (some 400 miles away from the source of the spill) the consequences of this spill are very much unknown.  The health of the people in the Gulf Coast area is obviously an immediate concern.

Little research has been carried out on the long-term effects of oil spills on people’s health.  Those who are currently doing research on the potential health risks of oil presume that most of the health concerns will be short term.  However, they do fear potential long-term damage to the liver, lungs, and kidneys.  These short-term and long-term health concerns would be resultant of the oil fumes that workers are subject to while cleaning up the spill.  Other research has found that those working to clean up the oil may experience temporary DNA damage that the body will repair itself over time.

On a more positive note, physical contact with the oil does not pose many health threats.  The oil itself is potentially harmless. Although some people may experience a rash from skin contact with oil, this is only temporary skin irritation.  Health officials announce that you are not in notable danger if you touch or swallow small amounts of oil, but it is not advised to do so.

What consequences will the Gulf Oil Spill have for human health?

How we choose to manage the present circumstances of the BP Oil Spill can be controlled.  Hence, BP has organized clean-up crews in a particular manner.  Complaints have been recorded of an irrational amount of volunteers “standing around” at clean-up sights.  What they don’t realize is that this particular strategy has been arranged to prevent potential health risks to the volunteers.  The volunteers at the spill clean-up spill sites are working in near 100 degree temperatures.  Extended water breaks and shorter working periods reduces the potential of heat-related health risks, such as heatstroke and dehydration.  It also increases the clean-up efficiency of the volunteers

One health concern that has been deemed inevitable is the mental health of residents in the area of the BP Oil Spill.  Mental health issues are bound to arise because it has happened in every past oil spill.  Residents in the areas affected by the oil spill have higher rates of depression and other mental health issues as a result of the spill.  This ensues as a direct result of damages to the resident’s homes, beaches, and jobs.  People lose their jobs because tourism in the area decreases as a direct result of the damages to tourist attractions (especially beaches).  Also, those in the fishing industry lose their jobs because the oil contaminates many fish and people are more concerned with consuming fish.

While working to clean up the most disastrous Oil Spill in US history, all those involved with the Spill must take precaution.  With so much unknown about the potential health threat of oil, research could potentially find that it is toxic.  It is best to take safety measures.  The oil itself contains organic compounds, which can be carcinogenic.  Those working with oil or around oil fumes have a high risk of exposure to these carcinogens in the oil, such as benzene.

In 2006, Massachusetts established a broader health care system to provide universal health insurance coverage to its residents while also cutting down costs. The Massachusetts health care reform features several crucial components that expanded coverage to more than 100,000 uninsured.  The reform requires all Massachusetts adults to enroll in a health insurance plan or risk penalty, while all employers must also provide health insurance to employees or pay a penalty. Low-income adults have the opportunity to join one of the state-run Commonwealth Care plans.

Massachusetts Must Control It's Health Insurance Costs

While Massachusetts has succeeded in expanding health insurance coverage, it has not succeeded in slashing costs. As of June 2010, Massachusetts has the lowest uninsured rate in the United States at 4.8 percent, having slashed the uninsured rate by 60 percent. Compare that to the United States as a whole, where 15.4% of citizens are not covered.  Massachusetts’ efforts in expanding covered should be classified as successful.

However, the successes of broader coverage cannot hide the plan’s inability to cut costs.  The wide coverage, coupled with state subsidies and reduced rivalry between health providers, has caused costs to rise. The Massachusetts Department of Insurance has denied insurers’ demands for rate hikes in an attempt to keep expenses low for consumers. Meanwhile, insurers argue that reducing rates without slashing health provider costs places undue stress on them. Premiums have increased substantially for individuals and families, while the use of the emergency room for non-emergencies did not markedly decrease, perhaps indicating a deeper issue: the primary care physician shortage.

The similarities between the Massachusetts plan and the 2010 US Affordable Care Act make Massachusetts’ successes and failures ever more glaring on the national stage. According to a report from Fortune Magazine, both the Massachusetts and Obama plans increase health care demands without addressing health care shortages.  Prices have gone through the roof, and according to Fortune, will not decrease until the government stops targeting insurers.  Insurance pools also grow more expensive as younger, healthier members drop out while sicker members stay in.  Subsidizing middle-income plans may also prove expensive, while additional state-mandated benefits have also strained the system.  According to Fortune, Massachusetts residents have begun to manipulate the system to optimize their health insurance benefits and subsidies.

If Massachusetts can successfully manage the costs associated with its health care reform, perhaps this will bode well for the Affordable Health Care Act.  Four years into the Massachusetts plan, costs have continued to skyrocket as more residents are covered. In the current economy, controlling costs is ever more crucial to the health care industry and to the country’s economy as a whole.  Solving the primary care and health provider shortage may prove a good step in shaving down costs.

In the end, it will be the costs, not universal coverage, that determine success for both the Massachusetts and federal reform programs. I hope that both reforms can find a way to cut costs beyond placing limits on insurers, perhaps by streamlining health care overall and improving the pool of preventative

Decided in 1973, the Roe v. Wade case forbade states from establishing laws that banned abortion.  It gave women the right to have an abortion in any US state up until their third trimester.  The ruling of this case has led to an ongoing abortion debate throughout the nation.  Anthony Kennedy, a Justice of the Supreme Court, is known for having a “swing vote” in many Supreme Court decisions.  However, people fear that a Republican President may choose to replace Kennedy.  Kennedy’s vote has always been important in the abortion cases.  If he were replaced, there is fear that Roe v. Wade may be overturned. This would allow states to enact laws against abortion at any point in the pregnancy if they so desire.

Supreme Court Nomination May Overturn on Roe v. Wade

If Roe v. Wade was overturned, the likelihood that we would see any variation in the amount of abortions in the US would be slim.  More problems may arise than would be solved in the event that Roe v. Wade was overturned.  If it was, there are about 20-25 states that would immediately enact laws against abortion.  This would make it more difficult for females to find a doctor offering abortion services.  However, it would not stop them from having abortions.  Females will either go to the states offering abortion services or find other means that are less safe and healthy than finding an available doctor.  Overturning Roe v. Wade would theoretically eliminate 170 doctors providing abortion services, which is less than 10% of all services available in the US.

Overturning Roe v. Wade will pose serious health and financial burdens.  As mentioned before, females will take more risky measures to have an abortion.  Those who decide to keep their baby are immediately faced with the high hospital costs and medical costs associated with having a baby.  Consequently, more women may consider taking contraceptives to prevent pregnancy in the first place.  However, this too can be expensive because many health insurance plans do not cover contraceptives.  If they do offer coverage, there is often a high out-of-pocket charge for the contraceptive prescription.  Also, there are very few health insurance companies that offer abortion coverage (most are private insurance companies).  It is likely that these health insurance companies will establish much higher costs in the states that would choose to allow abortion after overturning Roe v. Wade.

The replacement of Anthony Kennedy is not an immediate concern, but it is a possibility in the near future.  Kennedy’s retirement should not be in question because he is not likely to retire soon.  The only imminent threat to his position would be a Republican president, who may choose to replace Kennedy with a candidate who opposes abortion.  This decision, however, would have many repercussions and may not solve any abortion issues.

Even as federal Medicaid funds through the stimulus package dwindle, experts and state officials are collaborating on ways to identify and enroll eligible children in CHIP and traditional Medicaid this year. They are also working on similar strategies to target the millions of adults who will become eligible for Medicaid in 2014. Kaiser Health Network recently interviewed three health policy analysts for their take on how states can bring the nearly 5 million eligible but unenrolled children into the Children’s Health Insurance Program. The experts from the National Academy for State Health Policy, the Center for Children and Families at Georgetown, the Kaiser Family Foundation, and the Center on Budget and Policy Priorities enumerated several strategies states could adopt.

First, simplify Medicaid enrollment by giving states the option to enroll children automatically based on their records with other government agencies like those that administer food stamps or subsidized school lunch programs. In early 2010, Louisiana identified nearly 10,000 children via its food stamp program who were eligible for CHIP or Medicaid by not enrolled. Express lane eligibility could be expanded by developing a joint Medicaid/CHIP online application which eliminates the now-mandatory in-person interview. This expedited process is currently allowed for enrolling children under a 2009 federal law and 18 states already use it as an option. Federal law could further be changed to allow express lane enrollment for adults, especially those who will become Medicaid eligible in 2014. Creating an express lane process which applies to all Medicaid eligible individuals would encourage enrollment by lowering the barriers to entry. Eligibility terms could also be increased from 6 months to 1 year, and the process for renewing Medicaid coverage could be streamlined.

New Strategies Employed to Enroll More Children & Adults in Medicaid

States might also consider eliminating the asset test applied when determining adults’ Medicaid eligibility. This test has already been dropped for parents enrolling their children in most states. One big barrier to enrolling more of the Medicaid eligible population is the social stigma associated with being on Medicaid. Unfortunately, this stigma places Medicaid enrollees in the same category as welfare recipients. Though both these programs provide necessary services to families in need, “welfare” has taken on a negative connotation in popular culture, one which Medicaid has also acquired. In order to encourage a culture of coverage, states could rename Medicaid to something more appealing and which sounds less like a welfare entitlement. My home state of Connecticut already made such a change, renaming CHIP the “Husky” Program after our NCAA Champion UConn basketball teams.

Finally, experts suggested paying incentives to nonprofit social service agencies who help enroll children in Medicaid and CHIP. Some states including Oregon, California, Louisiana, New Hampshire, Illinois, and Indiana have had success enrolling thousands of kids via these groups using paid incentives. Any or all of these strategies could prove useful to Medicaid program administrators in the years to come as the pool of eligible individuals is set to swell tremendously.

Everyone nowadays is aware that the Gardasil vaccine administered widely to young girls can protect against four strains of the human papillomavirus, a sexually-transmitted disease which can lead to cervical cancer. But what about older women? A new study argues the vaccine is indeed effective in protecting women ages 24 to 45 from HPV.

About 3 out of 4 sexually active women get HPV at some point in their lives. Though there are more than 100 HPV strains , most are harmless and disappear on their own without treatment. Gardasil protects against four of the strains of the virus that, when untreated, do bear serious medical risks: two which cause genital warts (strains 6 and 11) and two which can lead to cervical cancer (strains 16 and 18). Gardasil is only approved for girls ages 9 to 24, but a rising population of older women (24 to 45) are at risk of HPV infection. This is because more and more women are reentering the dating scene in middle age after a period of monogamy, such as after a divorce.

The ongoing multicenter, parallel, randomized, controlled, double-blind study tested the immunogenicity, safety, and efficacy of the quadrivalent HPV vaccine in 3819 Colombian women ages 24 to 45, none of whom had a history of genital warts or cervical disease. 1911 women received the vaccine, and the other 1908 were given a placebo. The researchers found that among the per protocol population (3222 women), the vaccine had a 90.5% efficacy rate against all strains of the virus. There were only 4 instances of infection in the vaccine group compared with 41 in the control group. The vaccine had an 83.1% efficacy rate against the two most common strains (HPV 16 and 18). Only four cases appeared in the vaccine group versus 23 in the control group. Researchers also looked at the intention-to-treat population, which included women who had not received all 3 installments of the vaccine or who did have a pre-existing HPV infection. When these subjects were included in the calculations, vaccine efficacy against all 4 types of HPV was 31%; against strains 16 and 18 was 24%. Because Gardasil will not protect women who were infected by HPV before they received the vaccine, the lower efficacy in the above mixed population suggests the “public health effect of vaccinating women ages 25 to 45 will be smaller than that recorded after vaccinating susceptible adolescents,” said researchers. Therefore, the maximum effect of vaccinating older women will be seen only in those who were susceptible to infection (engaging actively with new sex partners) and had not been previously exposed to HPV. However, most of the women in the study who were or had been HPV-positive were positive to only one strain of the virus. This means that the quadrivalent HPV vaccine could still be beneficial in protecting older women against the HPV strains they had NOT been infected with.

Though these findings are encouraging, some scientists are not as optimistic that the Gardasil vaccine will be effective in the older female population. They claim the new study is simply too small and that the vaccine’s true efficacy in the study group won’t be seen for several more years; the study has only followed the women for about 2.2 years.

Even if longer-term and larger-scale studies confirm the efficacy of the vaccine for older women, the problem for many women who believe they could be at risk of HPV infection is that the vaccine is currently only approved for girls 9 to 24. This means that right now insurers will not cover vaccination for older women until the shots are proven effective and approved for the older population. The fact that the vaccine’s three shots cost about $375 (not counting fees the doctor may charge for the visits) means that though these study results are encouraging, few older women will pursue vaccination until insurance companies begin covering it for them.

Regardless of whether women at any age receive the Gardasil vaccine, all women should still receive routine Pap smears, which check for cancerous or precancerous changes in cervix cells. Pap smears are almost always covered by private insurance as part of a woman’s routine gynecological exams.

Government Health- Reform Plan Viewed as “Fallback” Option

The vociferous debate on whether to implement a government-backed health plan to compete against private insurers continues to thrive in Congress. Last week, Senator Olympia Snowe (R-Maine) met privately with several different members of Congress to discuss health care reform legislation. One option that Snowe supports and that continues to gain momentum in the search for a compromise is a “fallback public plan” that would be implemented in the next few years. Essentially, the fallback option gives private health insurers the chance to cut costs and increase accessibility before a government-backed public plan would be put in place. A similar option was included in the legislation that created Medicare Part D prescription drug coverage, but a public plan was never created because private companies were able to meet the legislation’s goals and standards. Snowe has had fruitful discussions with a group of bipartisan senators on the Senate Finance Committee, chaired by Sen. Max Baucus (D-Montana). “Fallback is on the table,” Baucus stated at a Kaiser Family Foundation on May 21. Despite the support of the fallback public plan among many bipartisan members of Congress, many have a very difficult time supporting any kind of government-backed plan. A group of House and Senate Republicans claimed on Tuesday the government-backed plan would have “the compassion of the IRS, the efficiency of the post office, and the incompetence of Katrina assistance efforts.”