Explaining Health Care reform: What are Health insurance Exchanges?

A number of recent health care reform plans call for the creation of a health insurance “exchange,“ a new entity intended to create a more organized and competitive market for health insurance by offering a choice of plans, establishing common rules regarding the offering and pricing of insurance, and providing information to help consumers better understand the options available to them.

An exchange is part of the plan aiming for universal coverage currently being implemented in Massachusetts (where it is called the “Connector“). It was also featured in proposals from the major Democratic candidates for President (including President Obama), in the Healthy Americans Act sponsored by Senators Ron Wyden and Bob Bennett (where they are called Health Help Agencies), and in a white paper released by Senate Finance Committee Chair Max Baucus. In all of these plans, the exchange is a key element in providing coverage to the currently uninsured and in facilitating changes to the insurance market, particularly for those who buy insurance on their own. Some proposals allow employers or employees to purchase coverage through the exchange as well.

This brief explains the purpose and function of exchanges, how they would relate to greater regulation of the insurance market, and some of the key questions likely to be addressed by any health reform proposal that calls for the creation of exchanges. purpose and function of an Exchange In the context of a health reform plan aiming for a substantial expansion in the number of people insured and universal access to affordable coverage, there are a number of functions envisioned for exchanges, including:

1.  offering consumers a choice of health plans and focusing competition on price. Exchanges offer enrollees a choice of private health insurance plans, and some proposals also envision including a public, Medicarelike plan. Covered services and cost sharing (i.e., deductibles, coinsurance or copayments, and out-ofpocket limits) would be organized or standardized in ways that make comparisons across plans easier for consumers. The aim is to focus competition among plans on the price of coverage and minimize the tendency for plans to vary benefits in order to attract healthier than average enrollees.

2.  providing information to consumers. In conjunction with offering a choice of health plans, an exchange is intended to provide consumers with transparent information about plan provisions such as premium costs and covered benefits, as well as a plan’s performance in encouraging wellness, managing chronic illnesses, and improving consumer satisfaction. The exchange could also serve a customer assistance function—typical for large employers—to assist consumers who encounter billing or access problems with their plans.

3.  Creating an administrative mechanism for enrollment. For people who obtain private insurance coverage  through work, the employer typically facilitates enrollment in a plan and the payment of the premium. This is especially true in larger businesses. An exchange could serve a similar function for people without access  to that kind of assistance, including people buying insurance on their own or who work for small businesses. The exchange could also be used to determine eligibility for and administer income-related subsidies. Alternatively, these functions could be handled by a government agency or through the tax system.

4.  moving towards portability of coverage. Coverage through an exchange can be de-linked from employment,  helping to make health insurance more portable for people moving from job to job. However, since  employment-based coverage would still exist under some proposals, insurance may not truly be fully portable. Exchanges also could coordinate enrollment shifts between Medicaid and subsidized private coverage for people with very low and potentially changing income

Healthy Lunches for Children

Children want lunches that taste good and keep them full, and parents want a healthy meal for their growing, active children. Children learn and focus better when they eat foods from the four food groups in Canada’s Food Guide. Nutritious lunches and snacks are best when they are tasty, handy, fun to eat, and safe from bacteria. What is a healthy lunch for children? Include a variety of foods from at least three of the four food groups: Vegetables & Fruit, Grain Products, Milk and Alternatives, and Meat and Alternatives. Children are eating too much fat, sugar, and salt, and not enough vegetables, fruit, milk products and whole grain foods. Unhealthy lunches at school are part of the problem.

Preparing a healthy lunch for your children No meal is a good meal if it is not eaten. Work together with your children to make a tasty and healthy lunch that they will enjoy eating.

• Involve your children in grocery shopping and planning their lunch.

• Let your children make their own lunch, choosing foods from Canada’s Food Guide..

• Add interest by combining new foods with old favourites.

• Everyone enjoys a surprise. How about a secret note, sticker or cartoon with lunch?

• Take time after dinner to prepare a healthy lunch with your children for the next day.

“My children eat the same food every day!”

Your children are developing their tastes and may be very choosy about what they will eat. The more often they see new foods, the more likely they will taste them and learn to accept them. Don’t give up if your children refuse a new food. Sometimes it takes up to 12 attempts before a new food is accepted. Help your children to accept a wider selection of foods by:

• Being a role model. Set an example by trying new foods yourself.

• Offering small amounts of the new food with a familiar one.

• Encouraging children to get to know new foods by including them in growing, buying, preparing or serving these new foods.

• Respecting that children have their own likes and dislikes

Vitamin D Deficienc

Once foods were fortified with vitamin d and rickets appeared to have been conquered, many health care professionals thought the major  health problems resulting from vitamin D deficiency had been resolved. However, rickets can be considered the tip of the vitamin D–deficiency iceberg. In fact, vitamin D deficiency remains common in children and adults. In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can precipitate or exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.

The discovery that most tissues and cells in the body have a vitamin D receptor and that several possess the enzymatic machinery to convert the primary circulating form of vitamin D, 25-hydroxyvitamin D, to the active form, 1,25-dihydroxyvitamin D, has provided new insights into the function of this vitamin. Of great interest is the role it can play in decreasing the risk of many chronic illnesses, including common cancers, autoimmune diseases, infectious diseases, and cardiovascular disease. In this review I consider the nature of vitamin D deficiency, discuss its role in skeletal and nonskeletal health, and suggest strategies for its prevention and treatment.

Humans get vitamin D from exposure to sunlight, from their diet, and from dietary supplements.

A diet high in oily fish prevents vitamin D deficiency.Solar ultraviolet B radiation (wavelength, 290 to 315 nm) penetrates the skin and converts 7-dehydrocholesterol to previtamin D3 which is rapidly converted to vitamin D3 Because any excess previtamin D, or vitamin D3 is destroyed by sunlight, excessive exposure to sunlight does not cause vitamin D3 intoxication.

Few foods naturally contain or are fortified with vitamin D. The “D” represents D2 or D3 Vitamin D2 is manufactured through the ultraviolet irradiation of ergosterol from yeast, and vitamin D3 through the ultraviolet irradiation of 7-dehydrocholesterol from lanolin. Both are used in over-the-counter vitamin D supplements, but the form available by prescription in the United States is vitamin D2 Vitamin D from the skin and diet is metabolized in the liver to 25-hydroxyvitamin D, which is used to determine a patient’s vitamin D status; 25-hydroxyvitamin D is metabolized in the kidneys by the enzyme 25-hydroxyvitamin D-1α-hydroxylase (CYP27B1) to its active form, 1,25-dihydroxyvitamin D. The renal production of 1,25-dihydroxyvitamin D is tightly regulated by plasma parathyroid  hormone levels and serum calcium and phosphorus levels. Fibroblast growth factor 23, secreted from the bone, causes the sodium–phosphate cotransporter to be internalized by the cells of the kidney and small intestine and also suppresses 1,25-dihydroxyvitamin D synthesis. The efficiency of the absorption of renal calcium and of intestinal calcium and phosphorus is increased in the presence of 1,25-dihy- droxyvitamin D. It also induces the expression of the enzyme 25-hydroxyvitamin D-24-hydroxylase (CYP24), which catabolizes both 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D into biologically inactive, water-soluble calcitroic acid.