Open enrollment provides dose of reality on health costs

Big, heady discussions are unfolding on Capitol Hill over revamping the nation’s health care system, but smaller, personal debates are playing out in living rooms and workplaces across the land as many Americans go through the annual ritual of open enrollment.

Michelle Enriquez, a program analyst for the city of Sacramento, said Friday that she agonized over her confusing options to see if she could save money.

“I don’t have the option of not taking health insurance,” said Enriquez, a single mother with a daughter in college.

Next year, she estimates that her share of the premiums for medical, vision and dental will jump about $75 a month to $536, although she’s eligible for a monthly $200 credit that can be applied toward health-related paycheck deductions. “These premiums are outrageous,” she said.

The outrage over health care’s rising costs is shared across the country as Congress tackles overhaul legislation.

Nationwide, next year’s premiums are expected to rise by an average of 6 percent, according to Hewitt Associates, a human resources consulting firm in Lincolnshire, Ill., that tracks the yearly data.

Certainly, there is heated debate about whether the legislative changes being proposed would help contain costs.

Nevertheless, the open-enrollment ritual serves as a dose of reality, according to Anthony Wright, executive director of the advocacy group Health Access California.

“Having people go through open enrollment gives a boost to health care reform,” Wright said. “It’s a time when people start seeing the problems with the current system. Open enrollment is when they face the increases in the cost of health care and face the limits of what they have.”

In many cases, he said, folks face confusion over whether their health coverage is truly adequate to protect them against the financial stresses from medical bills.

Enriquez said she will have to cut back on other expenses to afford the premium increase.

“I suppose we should be grateful we have a job,” Enriquez said, “but at this rate, how can we continue to afford to live?”

It certainly could be worse. She could have no health insurance at all, or have to pay the entire cost of premiums herself.

The Kaiser Family Foundation this week estimated that 1.5 million working-age adults became uninsured in 2007 because they lost their jobs.

But for many of the 162 million people still covered by employer-based health insurance in the United States, important deadlines loom. Decisions made in these days of reckoning are crucial, because they usually can’t be undone until the next open enrollment period.

Year after year, health premiums continue to rise – more than doubling over the past decade.

Employers expect workers to carry more of the burden – forcing some employees into a quandary during open enrollment. Should they attempt to save money now and opt for a cheaper plan with higher deductibles and out-of-pocket costs, or should they spend more money for a comprehensive plan that offers more benefits?

Dawn Deason, a communications managers for BloodSource, a Northern California blood bank, hasn’t worried much about health insurance. She’s happy with the coverage she has and plans few changes. She’s sticking with her current coverage.

Her premiums, however, have gone up a third for virtually the same coverage. She’ll be paying $60 a month, which she calls a bargain for the coverage she gets.

The cost of providing Deason health coverage is heavily subsidized by BloodSource, which employs 550 people from Merced to the Oregon border.

For the past two years, the company has absorbed the increased cost of providing health insurance to its 550 employees, but BloodSource decided to pass on some of the increase next year, said Jennifer Griffith, the director of human resources. “Our employees are seeing a small increase and a few plan design changes, but the impact is relatively minimal.”

“All in all, we’re not thrilled about the increases, but at least it’s manageable,” Griffith said.

Recent studies, however, show an acceleration in the rising cost of premiums.

In 2009, the annual cost to provide health coverage for a typical family was $13,375, up from $5,791 a decade ago – an increase of 131 percent, according to the Kaiser foundation.

What’s more, employees are being expected to carry more of the load. The typical family will pay $3,515 this year in health premiums, a 128 percent increase over 10 years ago.

“This is really a signal that the problems of rising cost affect everybody, that the increasing cost of health care is not just a theoretical phenomena,” said Marge Ginsburg, executive director for the Center for Healthcare Decisions, a nonpartisan policy group based in Rancho Cordova.

“For those with health insurance, this is real,” Ginsburg said. “And I hope they’re making the connection.”

The connection, she said, is that rising premiums and other health care costs are at the heart of the debate in Washington.

“If there’s one consistent message we’ve been hearing about health care, it’s that it has to be affordable.”

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Tell us your open-enrollment story

Open enrollment, that annual head-scratching ritual, is again upon many of us. We’d like to hear about the tough decisions you’ll have to make. Have your insurance premiums increased and benefits changed? Let The Bee health care writer Bobby Caina Calvan know what you’re going through. Reach him by phone at (916) 321-1067 or via e-mail at bcalvan@sacbee.com. Please include a phone number in your e-mail.

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Sacramento-area flu-shot strategy: Seek out seasonal; wait (mostly) on H1N1



Alexis Meron, a senior at Sacramento State, winces Wednesday as she gets a flu shot. The annual campus “Phlagleblast” festival set up an area nearby where nurses inoculated more than 200 students. Young adults are a high-priority group to receive swine flu vaccine.

If you’re considering getting the H1N1 flu shot, forget it for now, unless you are pregnant or have a very young child.

While you wait for the H1N1 shots to become more widely available later this fall, officials recommend you get the seasonal flu shot.

But there’s a hitch there, too: Supplies have nearly dried up.

There’s been a delay in getting both vaccines to the public. Manufactures have been slow in delivering more of the seasonal vaccine. And making the H1N1 doses took longer than anticipated; they’re only now trickling out to doctors so the most-vulnerable get vaccinated against what’s proving to be a risky flu for children and those with weakened immune systems.

It still possible to find the seasonal shots in the Sacramento area. But because the supply is managed privately and the distribution uneven, it may take a little work to find who’s delivering the vaccine.

Be sure to call ahead for an appointment, as the supply situation changes. Here’s a guide to finding a seasonal flu shot.

Call your health care provider first, as the shot is likely to be covered by insurance. Many doctors are reporting shortages, so you may end up looking elsewhere.

Sacramento County clinics

• A drive-through clinic today, 10 a.m. to 1 p.m., at the Sears at 5901 Florin Road, Sacramento. The cost is $10.

• Free shots will be offered at the Robertson Community Center next Thursday, 10 a.m. to 2 p.m., at 3525 Norwood Ave., Sacramento.

• Free flu shots will be offered at the Pannell Center Thursday, Nov. 5, from 10 a.m. to 2 p.m., at 2450 Meadowview Road, Sacramento.

Placer County clinics

There will be a $20 charge.

• Tuesday, 10 a.m. to 1 p.m., at the Multipurpose Senior Center, 11577 E Ave., Auburn.

• Thursday, 9 a.m. to noon, at the Maidu Community Center, 1550 Maidu Drive, Roseville.

Other clinics

• Sutter VNA & Hospice is hosting a public clinic today, 9 a.m. to 5 p.m., at the Carmichael Honda dealership, 6151 Auburn Blvd., Citrus Heights.

• Sacramento International Airport’s clinics still have supplies. The clinics are open Monday through Friday, 7 to 11 a.m. and 2 to 6 p.m.; Saturday, 7 to 11 a.m.; and Sunday, noon to 6 p.m. Weekend hours are subject to change. Call (916) 446-4449.

Retailers

Retail clinics charge around $30.

• Rite Aid still has shots; call ahead for appointments.

• Safeway still has adequate supplies. Call ahead because some pharmacies administer vaccines only at certain times.

• Most Walgreen’s are out, and supplies will not be re-stocked.

• Raley’s, Wal-Mart and Costco report being out of the seasonal vaccine.

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H1N1 concerns lead 2 Vacaville schools to close

Two Vacaville schools were closed today amid concerns about the the H1N1 virus, which authorities said might have contributed to the death of a Vacaville first-grader Sunday.

Browns Valley Elementary School officials alerted parents that it will be closed today and Monday. The first-grader who died Sunday attended the school. Tests confirmed the child had H1N1, but authorities stressed that it has not been confirmed as the cause of death. The child’s name has not been released.

Vacaville Christian High School also is closed today. School officials said numerous faculty members and students at the school are ill, although it is not known how many of them might have H1N1. Efforts to clean and sterilize the school are ongoing, and the school is scheduled to reopen Monday.

On Thursday night, Vacaville residents, some of them parents of Browns Valley Elementary School students, attended a meeting at Vacaville City Hall. Some expressed anger that school officials delayed closing Browns Valley after the death of the first-grade student. School officials said they did not immediately close the school as a result of one reported illness.

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UC Davis study of kids’ blood mercury levels finds no autism link

In one of the largest studies yet, UC Davis researchers said Monday that they found no real difference in blood mercury levels of children with, and without, autism.

The study, published in Environmental Health Perspectives, measured blood mercury levels of 452 children, 249 of whom had autism. Those with autism had lower levels, but it was because they eat less fish. Once researchers took fish consumption into account, the difference disappeared.

The levels were similar to those found in national samplings of children covering a similar age range.

“It’s a pervasive belief that children with autism have tons of metal in them,” said co-author Irva Hertz-Picciotto, an environmental epidemiologist at UC Davis. “We could not measure levels in brain or other tissues, but mercury concentrations circulating in the blood of children with autism were similar to levels in other children.”

Hertz-Picciotto cautioned that the study measured only current mercury levels in children, not exposure that may have happened earlier in life.

“This isn’t a study asking whether mercury causes autism,” she said.

High levels of mercury have been known to cause severe neurological damage, and there have been hypotheses pointing to mercury as one of the possible causes of autism.

The number of autism diagnoses, characterized by abnormal social interactions and communication, has increased dramatically of late.

Another study published this month in the journal Pediatrics estimated autism’s prevalence to be 1 in 91 children, an increase from the rate of 1 in 150 children reported by the Centers for Disease Control and Prevention in 2008.

While the increase is in part due to increased awareness of autism, experts are agreed that it is also directly related to environmental factors.

Another study published last year by Hertz-Picciotto documented a 600 percent increase in autism diagnoses in California between 1990 and 2006, and estimated 400 percent of that was due to environmental factors.

In recent weeks the new H1N1 vaccine has reignited the issue of autism and mercury. Public health officials are pushing hard to vaccinate all young children against H1N1. But a significant proportion of parents are reluctant to give children the vaccine, in part because thimerosal – a mercury-containing preservative – is present in multidose vials of the vaccine. Thimerosal is not present in single-dose vials and the nasal spray vaccine. Rumors of a link persist, even though the CDC has declared the link between vaccines and autism unsubstantiated.

The study announced Monday did not look at the vaccine. Nor did it address how earlier exposure to thimerosal may have affected children.

The new report is part of a large Sacramento-based study seeking to cast a wide net over environmental and genetic factors in relation to autism. Childhood Autism Risks from Genetics and the Environment Study (CHARGE) has enrolled over 1,000 children since its inception in 2003.

There is a great need for credible research in the arena of autism and the environment, experts said.

“It’s a problem that the issue of environmental factors has not been researched to the degree it needs to be,” said Lee Grossman, head of the Maryland-based Autism Society.

The comprehensive nature of the Sacramento study will help guide clinicians, said Antonio Hardan, director of Stanford Medical School’s Autism and Developmental Disabilities Clinic.

“There have been similar studies but not as good as this one,” Hardan said. “This will really add to the literature.”

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Judge halts cuts to California in-home aid

A federal judge on Monday halted the state of California’s plan to cut or reduce caregiver services for 130,000 disabled and low-income seniors starting Nov. 1.

Judge Claudia Wilken in Oakland imposed a preliminary injunction against the plan, which is intended to cut $82.1 million this year out of In-Home Supportive Services.

The Department of Social Services planned the cuts in the wake of budget reductions approved by the state Legislature and Gov. Arnold Schwarzenegger.

Wilken’s order freezes the state’s plan pending future hearings on a lawsuit filed against the state by groups representing seniors and the disabled as well as caregiver unions.

The groups argue that the state’s plan for deciding whom to drop from services is an arbitrary method that violates federal protections for the disabled and elderly.

The state wanted to send out notices last Thursday to all 130,000 who were going to be affected by the cutbacks, but Wilken blocked that plan with a temporary restraining order.

On Monday, Wilken ordered the state to instead send out notices to all those who were going to be affected to reassure them that services will not be cut Nov. 1.

“I am very relieved,” attorney Melinda Bird of Disability Rights California said.

Bird said that the notices the state must now send are part of a directive from the judge to reassure people they won’t be left without help.

“The notices are like a prophylactic ‘Don’t Worry’ notice,” Bird said.

Bird said the judge’s order shows she is taking disabled activists’ lawsuit seriously.

The groups contend that vulnerable people with dementia and mental illness could lose vital caregiver services if the state is allowed to use a “functional index score” to decide whom to cut from the program.

Disabled people or seniors who can feed and clothe themselves can score well, the groups say, but they may suffer from dementia or other mental problems that require some hours of in-home care for cooking, cleaning and shopping aid.

The Department of Social Services argued in court Monday that the cuts could not be stopped by Nov. 1 because new information had already been put into the state’s computerized payroll system.

Lizelda Lopez, a department spokeswoman, issued a statement Monday repeating this claim: “We will comply with the judge’s order, but we cannot quickly reverse some of the complex payroll system changes that have already been made, so there may be some delay.”

Lopez said that the department will review the judge’s detailed order and “do our best to communicate” with program recipients.

Bird said that the state has proposed asking counties in California to assume the burden of reprogramming data so that recipients won’t have services cut as of Nov. 1.

Lopez said she needed more information before commenting on this proposal.

Bird said that her group will file objections with the court Tuesday, arguing that such a plan is too costly and difficult for counties to carry out.

The caregiver program pays in-home caregivers for seniors and the disabled through a mix of federal, state and county money, with some contributions from recipients’ own money.

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Study adds to evidence against autism-mercury link

In one of the largest studies yet, UC Davis researchers said Monday they found no real difference in blood-mercury levels of children with, and without, autism.

The study, published in Environmental Health Perspectives, measured blood mercury levels of 452 children, 249 who had autism. Children with autism had lower levels, but it was because they eat less fish. Once researchers took fish consumption into account, the difference disappeared.

The levels were similar to what has been found in national samplings of children covering a similar age range.

“It’s a pervasive belief that children with autism have tons of metal in them,” said co-author Irva Hertz-Picciotto, an environmental epidemiologist at UC Davis. “We could not measure levels in brain or other tissues, but mercury concentrations circulating in the blood of children with autism were similar to levels in other children.”

Hertz-Picciotto cautioned that the study only measured current mercury levels in the children, not exposure that may have happened earlier in life.

“This isn’t a study asking whether mercury causes autism,” she said.

High levels of mercury exposure have been known to cause severe neurological damage, and there have been hypotheses pointing to mercury as one of the possible causes of autism.

The number of autism diagnoses, characterized by abnormal social interactions and communication, has increased dramatically in past decades.

A study released this month in the journal Pediatrics estimated autism’s prevalence to be 1 in 91 children, an increase from 1 in 150 children, reported by the Centers for Disease Control and Prevention in 2008.

The study released today is part of a large, Sacramento-based study that seeks to cast a wide net over environmental and genetic factors in relation to autism. The study, called Childhood Autism Risks from Genetics and the Environment Study (CHARGE), has enrolled over 1,000 children since its inception in 2003.

There is a great need for credible research in the arena of autism and the environment, experts said.

“It’s a problem that the issue of environmental factors has not been researched to the degree it needs to be,” said Lee Grossman, head of the Maryland-based Autism Society.

The comprehensive nature of CHARGE will help guide clinicians, said Antonio Hardan, who is director of Stanford Medical School’s Autism and Developmental Disabilities Clinic.

“There have been similar studies but not as good as this one,” he said. “This will really add to the literature.”

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Swine flu vaccine starts arriving in Sacramento; much more to come



Andrea Plancarte tries to comfort her daughter, Rosalinda, before an H1N1 vaccine was administered to the 7-year-old in the form of a nasal spray Thursday at the Effort’s Oak Park Clinic. Behind them, Rosalinda’s younger sister, Marieli, is reassured by cousin Rudy Lopez after she received the swine flu vaccine.

Kennedy Joplin’s roar was deafening – perhaps excruciating for her father, Steven Joplin.

The 2-year-old squirmed and wailed on Thursday as a nurse sprayed into her nostrils one of the Sacramento region’s first doses of the H1N1 vaccine.

“It hurts me, too. I don’t like seeing daddy’s little princess cry,” said Joplin, a soldier based in Fairbanks, Alaska, doing his fatherly duties before returning to his military duties. “She spends a lot of time with other kids in child care, and with flu season coming, better safe than sorry.”

Kennedy quickly learned there was actually little pain, and her sobs were soothed by a lollipop.

At the Effort’s Oak Park Clinic, a handful of parents were among the first to have their children vaccinated against the H1N1 strain of influenza.

Public health officials across the state have been urging parents to vaccinate children as soon as possible for the novel H1N1 flu strain, which has emerged as a global public health threat.

The Centers for Disease Control and Prevention said the H1N1 virus is now widespread in at least 37 states, including California.

Since April, when the first cases of so-called swine flu were reported, there have been 3,051 recorded cases and 219 deaths attributed to the virus in California.

Public health officials expect the vaccine to be available to the general public in less than a month.

As of Monday, about 10 million doses of both forms of the vaccine were available to be ordered nationwide.

Sacramento County plans to hold mass H1N1 vaccination clinics in November, after finishing the seasonal flu vaccine clinics, said Dr. Glennah Trochet, Sacramento County’s public health officer.

H1N1 vaccines continued arriving at clinics across the state this week, as health officials girded for an expected outbreak of the new flu virus. The first wave of doses will be given to the most vulnerable of the population – young children and pregnant women.

The Effort’s Oak Park Clinic had an order of about 50 doses of a nasal spray intended for children between 2 and 9 years old and adults in close contact with infants under 6 months.

More of the vaccine is expected to arrive at the clinic in the next few weeks, said Diane Oran, the clinic manager. The clinic ordered 3,000 doses of the vaccine that will be administered through shots and 700 through nasal sprays, said Diane Oran. She urged parents to vaccinate children: “They are really putting them at risk. It’s smart to prevent illness in your child.”

In Sacramento County, public health officials expect to distribute 10,000 of the nasal sprays to area clinics and health care providers, as part of its allotment from the state.

The state distributed 350,000 doses of the vaccine this week, 150,000 of the spray variety intended for children – in addition to the 400 doses distributed last week, said Ken August, spokesman for the state Department of Public Health. In all, the state expects to distribute more than 22 million doses of the vaccine in the coming months.

The most vulnerable populations will have priority for the initial wave of doses, according to county officials.

Keith Miles of Curtis Park brought his son Carter, 5, for his vaccination.

Carter knew what to expect: “They spray into your nose,” he said. He already knows the routine when flu season hits. Usually, it’s a shot to the arm.

His mother lost a lung to an infection, and the family doesn’t want to take any chances. “We have to make sure we all stay healthy,” said the boy’s father.

Rudy Lopez, 12, didn’t meet the criteria for the H1N1 vaccine – the first doses are reserved for children between 2 and 9 – so he got one for the seasonal flu, an important vaccine that shouldn’t be overlooked. He’ll get his turn for the H1N1 vaccine in the coming weeks, when more of the drug becomes available.



Five-year-old Carter Miles of Curtis Park receives the H1N1 flu vaccine, which is expected to be widely administered at local clinics in November.



The H1N1 vaccine wasn’t so bad for Kennedy Joplin, 2, but she’s less happy as she gets a seasonal flu shot Thursday at the Effort’s Oak Park Clinic. At left is her father, Steven Joplin.

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Matsui defends health care overhaul in long-awaited town hall



Rep. Doris Matsui, D-Sacramento, greets Gloria Powell, 78, of Sacramento at her town hall meeting Saturday at Sutter Middle School. She asked constituents to be patient with Congress. “This is like the third quarter of a football game,” she said. “We want to sign at the end of the year so we can begin reform on January 1. … We are taking the time to do it right.”

Unlike noisy town-hall meetings on overhauling health care that dominated the summer in Northern California, Saturday’s session in Sacramento was more pep rally than shouting match.

The meeting, hosted by Rep. Doris Matsui, D-Sacramento, drew about 700 people and only a few boos. And it drew a pledge from Matsui to stand fast by a controversial public health insurance option, expanded coverage and medical care cost-cutting – the hallmarks of insurance overhaul demands by left-leaning Democratic Party members in Washington, D.C.

“I want to make sure no family in Sacramento risks bankruptcy just because a loved one gets sick,” Matsui said to cheers. “This bill will ensure that 97 percent of Americans have access to health insurance. Right now, 100,000 people in this community are uninsured.”

It was Matsui’s first in-person meeting with constituents in the health care debate, and it may be her last. Matsui has been criticized for not having a meeting earlier, but she said conversations with constituents now will have greatest impact on reform.

“We are still in the middle of the process, but now we know the ideas,” she said.

She asked constituents to hang tight through the politicking in Washington – a process expected to last at least another couple of months.

“This is like the third quarter of a football game,” she said. “We want to sign at the end of the year so we can begin reform on January 1. … We are taking the time to do it right.”

At Saturday’s Democratic rally in Sacramento, health insurance companies were vilified.

Dan Monahan, a Sacramento surgeon, said when he began practicing 22 years ago he naively thought health insurance companies wanted the best for his patients. He said he discovered they were less interested in patients’ health than saving money by denying services.

“No other country in the world has for-profit insurance companies like we do,” he said.

One lone man made a fuss and was quelled by a policewoman. Bill Cooper of Sacramento wore a “Nobama” T-shirt and held a mini American flag. He said he opposes a public option because it would not increase competition among health insurers.

“You’re wrong!” he shouted repeatedly, while other nearby participants rolled their eyes. “You’re just freaking lying!”

Despite the friendly atmosphere, questions directed at Matsui were diverse. Some participants asked personal questions, referencing their own experiences with the health care system. Matsui’s audience at Sutter Middle School was a racially diverse mix of young and old.

Some of Matsui’s toughest questioning came from liberal critics, such as Claire Toomay, a McClatchy High School teacher, who pointedly asked about the influence of the health care industry in drafting overhaul legislation.

Matsui’s response was uncharacteristically animated.

Insurance companies don’t want a public option, she said, but she supports it. Pharmaceutical companies have been reluctant to negotiate Medicare drug prices, but she wants them to, she said.

“Health care reform may work this time because everyone is around the table,” she said. “In the Clinton administration, we froze them out.”

Toomay said the passion from Matsui was unexpected. Matsui’s town hall was a contrast to forums hosted by her congressional colleagues this past summer when feverish debate produced standing-room-only crowds.

On Saturday there were no real clashes. There were no dueling pickets outside the town hall, as there were at town halls held by Rep. Dan Lungren, R-Gold River.

There was, however, Charles Johnson of Sacramento, who bemoaned the complexity of the nation’s current health-care system. Enrolled on Medicare Advantage, he said he feels overwhelmed by the unfamiliar insurance plan choices and all the acronyms he faces.

“You have to have a lawyer to get insurance,” he said.

But the one comment that elicited a prolonged standing ovation was something everybody seemed to understand.

“This debate ends up being about a moral right,” said Gay Jones of Sacramento. “Everybody needs to make this moral decision – that everybody is entitled to health care.”

Matsui is on the House Energy and Commerce Committee, one of three House panels that have drafted health care overhaul bills. Matsui said her committee’s plan is deficit neutral and that those who are happy with their private coverage or Medicare would continue to have the same. For the uninsured, she said, she supports a health insurance exchange marketplace.

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Pediatric H1N1 vaccine availability depends on medical group

Some medical groups have received supplies of vaccine against the H1N1 flu virus, but it’s not yet available to all kids.

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