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What's in Trump's health care executive order?


The president says his action would give millions of Americans more access to affordable coverage. Supporters, such as Republican Senator Rand Paul of Kentucky, say the order will make it easier for people to obtain large group coverage, which is generally considered the best insurance to have.

But critics argue it could lure younger, healthier consumers away from Obamacare with cheaper, but skimpier policies, while leaving sicker folks to pay higher premiums on the exchanges. Many industry and consumer groups, including the American Cancer Society and the American Hospital Association, voiced concerns about Trump’s move.

“Today’s executive order will allow health insurance plans that cover fewer benefits and offer fewer consumer protections,” Tom Nickels, executive vice president of the hospital group, said in a statement Thursday. “In addition, these provisions could destabilize the individual and small group markets, leaving millions of Americans who need comprehensive coverage to manage chronic and other pre-existing conditions, as well as protection against unforeseen illness and injury, without affordable options.”

Nothing is likely to happen immediately. It could take months for the administration to craft new regulations and guidance to carry out the order.

Here’s what the executive order would do:

Let more small businesses join together to buy coverage. Trump is directing the Labor Department to study how to make it easier for small businesses, and possibly individuals, to collectively buy health insurance through association health plans. Small employers may expand their ability to offer group coverage across state lines, providing them with a broader range of policies at lower rates.

Association health plans are usually sponsored by trade organizations or interest groups. But the administration could amend the rules governing these plans so they are no longer subject to state regulation, said health policy experts. Instead, the nationwide plans may come under the same federal oversight as large-employer policies.

Related: Trump begins dismantling Obamacare with executive order

Large group plans, however, do not have to adhere to all of Obamacare’s provisions, such as the requirement to provide comprehensive benefits that cover prescription drugs, mental health and substance abuse. The regulatory switch could also allow association plans to deny coverage to the group or set rates based on the medical history of those in the group, so plans with younger, healthier members could offer lower premiums.

Employers participating in these plans would not be allowed to exclude employees or develop premiums based on health conditions, the administration said. But the associations could charge certain employers more than others based on their workers’ medical histories, experts said.

Extend short-term coverage policies. The order would allow more consumers to purchase short-term health insurance plans. It directs agencies to lengthen the coverage of these policies and permit renewals.

They were originally designed to insure people for several months while they were between jobs or going through other life transitions. Some plans provided coverage for up to a year. The Obama administration last year limited the duration to 90 days.

These plans may have lower rates, but they typically provide less comprehensive coverage. They are not subject to Obamacare’s regulations, so they can exclude those with pre-existing conditions or base rates on consumers’ health background. This allows them to cherry pick whom to sign up and to offer lower rates to the healthy.

Those who have short-term plans now are not considered insured and are subject to the Obamacare penalty.

Related: One way Trump could change health insurance

Expand employers’ ability to give workers cash to buy coverage elsewhere. Health reimbursement arrangements are not well-known, but they figure into Trump’s executive order. Employers use them to provide workers with tax-free funds to pay for health care costs, mainly deductibles and co-pays.

Prior to Obamacare, employers used HRAs to reimburse workers for a wider array of expenses, including premiums. The health reform law barred the use of HRAs to buy policies on the individual market.

Trump’s executive order directs federal agencies to expand the flexibility and use of these employer-funded accounts to give workers more coverage choices. Health care experts expect HRAs will be allowed to pay premiums for individual market policies.

Republican leaders abruptly pull their rewrite of the nation’s health-care law...


By Mike DeBonis, Ed O’Keefe and Robert Costa

Republican leaders abruptly pulled their overhaul of the nation’s health-care system from the House floor on Friday, a dramatic defeat for President Trump and House Speaker Paul D. Ryan that leaves a major campaign promise unfulfilled and casts doubt on the Republican Party’s ability to govern.

The decision leaves President Barack Obama’s chief domestic achievement in place and raises questions about the GOP’s ability to advance other high-stakes priorities, including tax reform and infrastructure spending. Ryan (R-Wis.) remains without a signature accomplishment as speaker, and the defeat undermines Trump’s image as a skilled dealmaker willing to strike compromises to push his agenda forward.

In an interview with The Washington Post, Trump deflected any responsibility for the setback and instead blamed Democrats. “We couldn’t get one Democratic vote,” he said.

“I don’t blame Paul,” Trump added, referring to Ryan.

Trump said he would not ask Republican leaders to reintroduce the legislation in the coming weeks, and congressional leaders made clear that the bill — known as the American Health Care Act — was dead.

Which Republicans forced Trump to pull the health-care bill

Shortly after the decision, Ryan told reporters his party “came really close today, but we came up short.” He added: “We’re going to be living with Obamacare for the foreseeable future.”

“It’s done, DOA,” said Energy and Commerce Committee Chairman Greg Walden (R-Ore.), who drafted much of the legislation. “This bill is dead.”

Instead, Republican leaders said, they would wait for the Affordable Care Act to encounter fatal problems, believing that Democrats will then want to work with them to make changes.

“As you know, I’ve been saying for years that the best thing is to let Obamacare explode and then go make a deal with the Democrats and have one unified deal,” Trump said. “And they will come to us, we won’t have to come to them.”

It remains far from certain that Republicans, in control of the White House and both houses of Congress, will be able to credibly foist responsibility for the nation’s health-care woes onto Democrats. What is certain is that Republicans continue to have difficulty turning their campaign promises into legislative action.

For seven years, GOP candidates have pledged to repeal the Affordable Care Act, which expanded Medicaid and created subsidized, state-based exchanges to expand health insurance coverage to 20 million Americans, decrying the taxes and government mandates it enacted.

“Since 2010, every Republican, with the exception of probably a handful, has campaigned from dogcatcher on up that they would do everything they could to repeal and replace Obamacare,” White House press secretary Sean Spicer said Friday. “To get in and say you’re going to do something else would not be fair to the American people.”

3 reasons the Trump-backed health-care bill stalled

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Congress was expected to vote on a health-care plan March 23. After a day of negotiations, the vote got pushed back. Here are three reasons why. (Video: Sarah Parnass/Photo: Melina Mara/The Washington Post)

But in that time, the party never coalesced around a consensus alternative to the law, and the scramble to develop one after Trump’s election revealed some of the reasons: Republicans were loath to repeal popular ACA provisions such as a requirement that insurers cover those with preexisting conditions and dependents up to age 26 but wanted to repeal the taxes and the individual mandate to have insurance that helped make those provisions possible.

The policy difficulties were amplified by an ideological cleavage within the House GOP. Conservative hard-liners chafed that the Ryan-drafted bill left too much of the ACA in place and enshrined a federal role in health insurance markets, while moderates feared that cuts to tax subsidies and Medicaid would leave their constituents uncovered and their states with gaping budget gaps.

The drama on Capitol Hill unfolded amid new evidence that public opinion was running against the bill: A Quinnipiac University poll released Thursday found that U.S. voters disapproved of the legislation 56 percent to 17 percent, with 26 percent undecided.

Signs of trouble across the Republican spectrum were evident by midday Friday, as lawmakers streamed onto the House floor for a procedural vote.

In one stunning defection, House Appropriations Committee Chairman Rodney Frelinghuysen (R-N.J.) announced midday that the bill was “unacceptable” and that changes made late Thursday to placate conservatives “raise serious coverage and cost issues.”

He was joined by rank-and-file members such as Rep. David Joyce (R-Ohio), a low-key appropriator, and Rep. Barbara Comstock (R-Va.), a longtime Ryan ally who represents a competitive Northern Virginia congressional district.

But the White House and House leaders both saw the key bloc as the House Freedom Caucus, a group of roughly three dozen hard-line conservatives who made numerous demands of the bill since January — including a flat repeal of the ACA, a major reworking of the GOP bill’s tax incentives and new Medicaid restrictions.

Most of those demands were rejected, primarily due to the political reality of holding a Republican majority together in support of the bill.

The Freedom Caucus chairman, Rep. Mark Meadows (R-N.C.), became a central player in the negotiations, however, and the group kept an open line to the White House — particularly with chief strategist Stephen K. Bannon and Office of Management and Budget Director Mick Mulvaney, who had been one of its founding members. The group made a final demand this week: The bill had to eliminate a set of ACA insurance mandates that, it argued, were a key factor in driving up premiums.

In a Thursday morning White House meeting, Trump made what would be his final offer: The bill would gives states the option to eliminate some of the mandates, 10 “essential health benefits,” but would leave others in place.

That afternoon, the Freedom Caucus met to reject the deal. Hours later, Mulvaney came to a closed-door House GOP conference meeting to deliver a final ultimatum, saying Trump was ready to move on if the bill failed Friday. Afterward, members lined up at microphones to deliver emotional pleas for party unity. Some were veiled critiques of the Freedom Caucus; others were less veiled.

During the midday procedural vote Friday, Ryan asked Meadows if his group had changed its stance. It had not, Meadows told him — meaning as many as 20 hard-liners would oppose the bill. Twenty-two Republican no votes would sink the bill, and more than a dozen other members had announced their opposition by Friday afternoon.

Ryan left shortly after for the White House to tell Trump the bill would fail.

Meadows declined to answer questions after the bill was pulled on Friday. But several Freedom Caucus members said they would not be cowed by Ryan or even Trump — a figure most of them had enthusiastically supported.

“You know what? I came here to do health care right,” said Rep. Paul A. Gosar (R-Ariz.), who was one of six Republicans who voted against the procedural measure.

“A no vote means we save Donald Trump from a Democratic majority in 2019,” said Rep. Louie Gohmert (R-Tex.), one of Trump’s most ardent congressional supporters.

The defeat has left the remainder of the Republican governing agenda in Congress in tatters. A proposed corporate tax overhaul favored by Trump and Ryan depended, in part, on the health-care legislation proceeding — creating both political momentum and fiscal space for dramatic action.

Before the bill was pulled Friday, Rep. Bradley Byrne (R-Ala.) called it the “first big vote in the presidency of Donald Trump,” one that would be “a statement, not just about him and the administration but about the Republican Party and where we’re headed.”

“So much about political power is about perception. And if the perception is that you can’t get your first big initiative done, then that hurts the perceptions down the road about your ability to get other big things done,” Byrne said.

Trump had personally lobbied 120 lawmakers, either in person or on the phone, Spicer told reporters on Friday. The president, he said, had “left everything on the field.”

The White House did not think that defeat would slow other parts of Trump’s agenda, including tax reform and changes to immigration, Spicer added.

Vice President Pence, White House Chief of Staff Reince Priebus and Health and Human Services Secretary Tom Price also engaged in last-ditch attempts to win over members Friday — including a midday huddle with Freedom Caucus members at the Capitol Hill Club, a GOP social hall next door to the headquarters of the Republican National Committee.

The heart of the argument made by GOP leaders was that keeping the Affordable Care Act would be a worse outcome than passing a potentially flawed replacement. That worked with some Republicans, but not all.

Rep. Joe Barton (R-Tex.), a Freedom Caucus member who said he would have voted for the bill, rejected the idea that the hard-liners were to blame.

“I thought we were constructive,” he said. “Because of the sensitivity of the issue, some of the normal compromise mechanism didn’t quite get us there. That doesn’t mean they won’t get us there sometime in this Congress.”

At the Capitol, a deflated Ryan said he would confer with fellow Republicans in the coming days about how to proceed, but he made clear health care would no longer be a central agenda item.

“Moving from an opposition party to a governing party comes with growing pains,” Ryan told reporters. “We’re feeling those growing pains today.”

“Doing big things is hard,” he added.

Trump said he had no problem waiting for Democrats to seek cooperation with Republicans on health care: “I never said I was going to repeal and replace in the first 61 days.”

In fact, Trump said repeatedly as a candidate and before his inauguration that he would work to repeal the ACA on his first day in office.

Where Trump And Clinton Stand On Health Care And Medicare...

(This is the second in a series of Next Avenue blog posts on where presidential candidates Donald Trump and Hillary Clinton stand on key issues of interest to Americans over 50. The first article was about where Trump and Clinton stand on Social Security.)

Health care is among the top four issues for registered voters in the upcoming presidential election, according to Pew Research poll results. Seventy-four percent said it was “very important” to their vote. That’s no big surprise. And more than 3,400 Next Avenue readers who participated in an online poll in January rated health care as their second most important concern in the election; the economy was Number One. (Our readers are generally age 50 and older, so some likely included Medicare in their response.)

Here is what Donald Trump and Hillary Clinton have said or written about their plans for health care and Medicare:

The Affordable Care Act

Donald Trump: He has called repeatedly for the repeal of The Affordable Care Act (aka Obamacare). But Trump has also said that he supports its primary tenet: the provision that all Americans be required to buy health insurance. On a CNN Town Hall Forum with Anderson Cooper in February, Trump said, “I like the mandate… I don’t want people dying on the streets.”

An April 8 article in The New York Times quoted James C. Capretta, a senior fellow at the conservative Ethics and Public Policy Center, saying Trump underestimates how engrained the Affordable Care Act now is. “It took a herculean political effort to put in place the Affordable Care Act,” Capretta said. Dismantling it and going in another direction “even incrementally, would take an equally herculean effort, with clear direction and a clear vision of what would come next. I just don’t see that in Trump’s vague plans to repeal the law and replace it with something else.”

Hillary Clinton: She has praised Obamacare and pledged to not only keep the law in place but to expand it.

“The Affordable Care Act was a critically important step toward the goal of universal health care, offering coverage to 20 million more Americans, and ensuring all Americans will never be denied coverage on account of pre-existing conditions or their gender,” the Clinton website says.

But there is more to do, Clinton says, including working with governors to expand Medicaid in states that have refused to do so and expanding access to affordable health care to undocumented immigrants.

Clinton also supports the creation of a “public option” within Obamacare, a government-run health insurance plan that would compete against private insurers.

Voters were more likely to say they trust Democrats (49%) than Republicans (38%) to do a “better job dealing with the future” of Obamacare, according to a July health poll by the Kaiser Family Foundation.

Health Care Costs

Donald Trump: He says on his site that he wants to change current law to allow the sale of health insurance across state lines. The increased competition will allow health care costs to go down, Trump says.

Trump also blames illegal immigrants for high costs. “Providing healthcare to illegal immigrants costs us some $11 billion annually,” he writes. “If we were to simply enforce the current immigration laws and restrict the unbridled granting of visas to this country, we could relieve healthcare cost pressures on state and local governments.”

Trump also favors allowing individuals to “fully deduct” health insurance premiums from their taxes. Today, you can only write off health insurance premiums to the extent that they and other out-of-pocket health costs exceed 10% of your adjusted gross income (7.5% if you’re 65 or older) or if you are self-employed.

Hillary Clinton: According to Clinton’s website, she would “build on the Affordable Care Act by requiring insurers and employers to provide up to three sick visits to a doctor per year without needing to meet the plan’s deductible first.”

She also calls for a “new, progressive refundable tax credit of up to $5,000 per family for excessive out-of-pocket [health care] costs.” That’s aimed at middle-class families who may not be able to benefit from current medical expense tax deductions. The lost tax revenue from the credit would be replaced for “by demanding rebates from drug manufacturers and asking the most fortunate to pay their fair share [of taxes],” Clinton says.

Both candidates have called for more transparency on health care costs.

Prescription Drug Costs

Total U.S. prescription drug sales in 2015 were more than $419.4 billion — 11.7% higher than in 2014, according to research published in May in the American Journal of Health-System Pharmacy. You don’t have to tell that to American consumers, especially older adults, who are dealing with rising prescription drug costs. A 2015 Kaiser Health Tracking Poll found that three-quarters of Americans believe prescription costs are unreasonable.

Donald Trump: He stunned Republicans by calling in January for Medicare to negotiate prescription drug prices, joining Clinton and Bernie Sanders in that proposal. Trump said it hasn’t been done thus far because politicians are beholden to pharmaceutical industry donations. But with his negotiation skills, he could accomplish it, he said, claiming this change would save billions of dollars. (Current law  doesn’t allow Medicare to negotiate with drug companies.)

Like Clinton, Trump has also called for a change in U.S. law to allow importation of drugs from foreign countries, including Canada, to save Americans money. One big problem with that idea: Critics say there is no way to guarantee that the drugs aren’t counterfeit or contaminated, as I wrote in a recent Next Avenue article.

Hillary Clinton: The area of Clinton’s site dedicated to drug prices says: “Hillary Clinton believes we need to promote competition and leverage our nation’s bargaining power to lower drug costs on behalf of Americans.”  That includes allowing Medicare to negotiate on drug prices on behalf of its beneficiaries.

The site also says: “Her plan will demand a stop to excessive profiteering and marketing by denying tax breaks for direct-to-consumer advertising and demanding that drug companies invest in R&D in exchange for taxpayer support — rather than marketing or excessive profits.”

Clinton, the site notes, will also “encourage competition to get more generics on the market” and “cap what insurers can charge consumers in out-of-pocket costs, putting money back in the family wallet.”

And as mentioned above, she has proposed allowing the importation of drugs from other countries, “with careful protections for safety and quality.”

Alzheimer’s Disease

Ken Dychtwald, a leading expert on aging-related issues (he’s president and CEO of the Age Wave consulting firm), just outlined what he described as “four essential transpartisan issues that must be addressed by Secretary Clinton and Mr. Trump during the coming months of debate and discourse — if the aging of America is to be a triumph rather than a tragedy.” No. 1 on Dychtwald’s list: A “moonshot” to beat the diseases of aging, including Alzheimer’s.

Alzheimer’s has become our scariest disease, he said, and the United States should “set a bold goal of stopping Alzheimer’s within a decade.” But that won’t happen without a massive shift in our scientific priorities, with much more money spent on research, Dychtwald said. He called for Americans to ask the candidates what bold measures they would take to beat Alzheimer’s “before it beats us.”

Donald Trump: He has no statement about Alzheimer’s on his site, but in answer to a question at the Iowa State Fair a year ago, Trump called the disease a “total top priority for me. I have so many friends whose family is devastated by Alzheimer’s. So, it’s — believe me, it’s a total priority. That’s something that we should be working on and we can get an answer.”

The GOP platform mentions Alzheimer’s once, in the context of advancing research: “Federal and private investment in basic and applied biomedical research holds enormous promise, especially with diseases and disorders like autism, Alzheimer’s, and Parkinson’s,” it says. The U.S. will achieve “modern miracles” through significant public and private investment and “the world’s best talent.”

Hillary Clinton: Her senior adviser on health care, Ann O’Leary, told Next Avenue’s Richard Harris at the Democratic National Convention that “in some sense, Alzheimer’s is her [Clinton’s] ‘moonshot’ proposal.”

Clinton’s campaign fact sheet says: “We can prevent, effectively treat, and make an Alzheimer’s cure possible by 2025.” To accomplish that, Clinton would invest $2 billion per year for research on it and related disorders; ensure the funding is consistent and “put the best and brightest on the case.”

She also says she intends to support Alzheimer’s caregivers by covering Alzheimer’s care-planning sessions through Medicare. And Clinton says she’d work with Congress to reauthorize the Missing Alzheimer’s Disease Patient Alert Program, to find those who wander.

The Democratic platform also mentions Alzheimer’s once, in a similar vein to that of the GOP’s: “Democrats believe we must accelerate the pace of medical progress, ensuring that we invest more in our scientists and give them the resources they need …We must make progress against the full range of diseases, including Alzheimer’s, HIV and AIDS, cancer, and other diseases, especially chronic ones.”


Donald Trump: The GOP platform advocates a “premium support model” for Medicare that would “guarantee to every enrollee an income-adjusted contribution toward a plan of their choice, with catastrophic protection.” In other words, privatization. Republicans would “save Medicare by modernizing it,” the platform says.

But Washington Post columnist Marc Thiessen on June 20 quoted Trump as saying, during the primaries, “Every Republican wants to do a big number on Social Security, they want to do it on Medicare, they want to do it on Medicaid. And we can’t do that. And it’s not fair to the people that have been paying in for years.”

Chief Trump policy adviser Sam Clovis, however, said in May that a Trump administration would consider trimming Medicare benefits, according to the Wall Street Journal. “After the administration has been in place, then we will start to take a look at all of the programs, including entitlement programs like Social Security and Medicare,” Clovis reportedly said. “We’ll start taking a hard look at those to start seeing what we can do in a bipartisan way.”

Hillary Clinton: In May, she took a step toward the position of her primary opponent Bernie Sanders and proposed that people as young as 50 or 55 be able to voluntarily pay to join Medicare. That would mean the 7 million people age 50 and over who are still uninsured (as of 2014) could potentially benefit, according to an analysis by Avalere, a health care consulting firm. Clinton calls her proposal “Medicare for more.” Her website now specifies that it would apply to people 55 and older, however.

Clinton has also said she will fight Republican proposals to privatize or phase out Medicare. And she will resist attempts by the GOP to weaken or repeal the Affordable Care Act, which “made preventive care available and affordable for an estimated 39 million people with Medicare and saved more than 9 million people with Medicare thousands of dollars in prescription drug expenses,” her website says.

Rural Americans are often left without adequate, affordable health care because it is not readily available nearby. Clinton says she favors making more health care providers eligible for reimbursements under Medicare for telehealth services.

Cortisone Steroid Shot...

If the question is “Should I get a cortisone shot?” the answer is “It depends.” Frustrating, right?

Cortisone shots (also known as steroid injections) can be a lifesaver, allowing patients to take part in everyday activities without pain. But there are also drawbacks to this treatment.

Knee InjectionCortisone shots can be given in almost any arthritic joint to relieve pain. Learn more: Steroid Injections

The biggest obstacle is that cortisone shots, particularly multiple shots to the same area, might accelerate the degeneration of soft tissue, which could make joint degeneration worse in the long term.

Cortisone shots can be given in almost any joint to relieve inflammation and the pain associated with it. A joint affected by osteoarthritis has lost cartilage, which results in joint friction and can lead to inflammation. Sometimes, this joint inflammation causes pain without causing a lot of visible swelling and redness.

In these cases, cortisone shots are often the first medical intervention recommended by doctors, after treatments such as rest and medications haven’t sufficiently relieved pain. Cortisone shots are typically an elective treatment, meaning it’s up to you to decide whether or not to get one.

If pain is preventing you from doing everyday activities, going to work, exercising, or is affecting your overall health and well-being, a cortisone shot may be worth considering. They are especially helpful if the pain relief they offer can jump start your efforts to get regular exercise or physical therapy that was too painful prior to your injection.

The pain and inflammation relief of a cortisone injection can last anywhere from 6 weeks to 6 months. However, because of its possible destructive effects, injections need to be spaced 4 to 6 weeks apart and you shouldn’t get more than 4 injections per year in the same location.

Further complicating matters, insurance plans may cover a cortisone injection but may not pay for other types of potentially pain-relieving injections that don’t cause tissue damage, such as viscosupplementation or PRP injections. Ideally, you should be making treatment decisions based on what is best for you, not what is covered by insurance.

Osteoarthritis requires ongoing pain management that may include everything from injections to activity modifications, exercise, stretching, and even diet. A cortisone shot should just be one part of a larger treatment plan. If you do decide to get a cortisone shot, talk to your doctor about how it will fit into your overall treatment plan.

Why Your Joints Hurt When the Weather Changes...

Blame it on the barometric pressure: Any change in pressure, or the weight of the air pressing against the surface of the earth, can trigger joint pain or headaches in some people.

So when your great-aunt said she could “feel” a storm coming on, she was likely right.

“Arthritis affects everything else within the joint itself, including the joint lining, which we call the synovium, as well as the ligaments that are within the joint,” Dr. James Gladstone, co-director of sports medicine at The Mount Sinai Hospital in New York City, told “All of those tissues have nerve endings in them, so they’re going to feel changes in the weather as tightness in the joint, or stiffness.”


Although research conclusions on this have been mixed, anecdotal evidence from patients — and most experts — support a link between the two. According to a survey published in the journal Paintwo-thirds of people living with chronic joint complaints in San Diego, Nashville, Boston and Worcester, Massachusetts, believed there to be a link between their pain and weather changes.

The same goes for migraines, which patients also say are linked to weather patterns. Barometric pressure changes, as well as changes in humidity and temperature, might affect the pressure in the brain, or the way the brain blocks pain, Dr. Steven Graff-Radford, director of the program for headache and orofacial pain at the Cedar-Sinai Medical Center in Los Angeles, told last year, though the mechanism is somewhat unknown. “What’s quite clear, however, is that overcast, cloudy and rainy days produce more migraine headaches,” he said.

Depending on how severe joint or headache pain is, patients should see their doctors to create a changing-weather treatment plan, Dr. Gladstone said.

As the seasons shift, weekend warriors who don’t typically have joint pain should take extra precautions, as well, he added. “Anything cold causes muscles, ligaments and tendons to sort of tighten up, and that makes them stiffer,” Dr. Gladstone said. “So if you’re going to be doing stuff in cold weather, you want to make sure you warm up well first, and as importantly, have protective clothing on, so you don’t get too cold.”

Stretching indoors, jogging in place (if you’re going for a run), heat creams and heating pads can all help loosen up stiff joints, Dr. Gladstone said, adding. “The main thing is to make sure you warm up well.”

As for weather-related pain, it hurts, but it’s only temporary: Your joints should return to normal as soon as the weather changes.

Top Fitness Trends in 2016...

Hello everyone! This week I have been struggling to find a simple, 1-shot topic to discuss on the blog. Just as my frustration was mounting, something came across my desk this morning that is the perfect subject for a light-hearted newsletter- fitness trends for 2016. With basketball season ready to crank up and preseason polls generating discussion, let’s take a look at a ‘preseason fitness-trend poll.’

Each year since 2006, the American College of Sports Medicine (ACSM) has conducted a survey of a diverse group of over 1000 fitness professionals worldwide to assess the top trends in the fitness industry in the coming year. The sample of fitness professionals is typically made up of both full and part-time personal trainers, group fitness instructors, gym owners, medical professionals, clinical exercise physiologists, students, and professors.

Survey respondents are asked to differentiate between ‘fads’ and ‘trends,’ and to focus on trends alone- something that influences the way that individuals behave (trend) as opposed to something that people are very enthusiastic about for only a brief period of time (fad.)

The survey results indicate what over 2,800 fitness professionals’ view as the fitness-related ideas and exercise modes that will be the most popular amongst those who participate in regular exercise in 2016. Without further ado, here are the top 10:

1. Wearable technology (first time in the Top 20- unranked to first!)

2. Body weight training (first appeared in the poll in 2013)

3. High-intensity interval training (HIIT) (#1 for 2014 and 2015)

4. Strength training

5. Educated, certified, experienced fitness professionals

6. Personal training (stable in top 10 for last 9 years)

7. Functional fitness

8. Fitness programs for older adults

9. Exercise and weight loss

10. Yoga

Positions 11-20: group personal training, worksite health promotion, wellness coaching, outdoor activities, sport-specific training, flexibility and mobility rollers, smart phone exercise apps, circuit training, core training, and outcome measurements.

Notable trends that fell out of the top 20 for 2016 include: children and exercise for treatment/prevention of obesity, worker incentive programs, and boot camp.

The number one trend for the upcoming year does not surprise me, and is actually encouraging. As indicated in the list, both wearable technology and smart phone exercise apps (#17) appeared in the Top 20 for the first time ever in this poll. Reliance on technology is ever-increasing, and some feel that technology is partially to blame for the increasing sedentary nature of modern life. However, if technology can be used to encourage physical activity, then it is absolutely a positive.

How can it help? Quite simply, it allows fitness participants and professionals alike to quantify and track progress. Nothing indicates progress more effectively to the client or the trainer than changing numbers. If technology allows us to more easily and efficiently show results, we may as well take advantage of it!

Sprains, Strains and Other Soft-Tissue Injuries...

The most common soft tissues injured are muscles, tendons, and ligaments. These injuries often occur during sports and exercise activities, but sometimes simple everyday activities can cause an injury.

Sprains, strains, and contusions, as well as tendinitis and bursitis, are common soft-tissue injuries. Even with appropriate treatment, these injuries may require a prolonged amount of time to heal.


Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries.

  • Acute injuries are caused by a sudden trauma, such as a fall, twist, or blow to the body. Examples of an acute injury include sprains, strains, and contusions.
  • Overuse injuries occur gradually over time, when an athletic or other activity is repeated so often, areas of the body do not have enough time to heal between occurrences. Tendinitis and bursitis are common soft-tissue overuse injuries.
Common Acute Soft-Tissue Injuries

Acute soft-tissue injuries vary in type and severity. When an acute injury occurs, initial treatment with the RICE protocol is usually very effective. RICE stands for Rest, Ice, Compression, and Elevation.

  • Rest. Take a break from the activity that caused the injury. Your doctor may recommend that you use crutches to avoid putting weight on your leg.
  • Ice. Use cold packs for 20 minutes at a time, several times a day. Do not apply ice directly to the skin.
  • Compression. To prevent additional swelling and blood loss, wear an elastic compression bandage.
  • Elevation. To reduce swelling, elevate the injury higher than your heart while resting.


A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. Ligaments stabilize and support the body’s joints. For example, ligaments in the knee connect the thighbone with the shinbone, enabling people to walk and run.

The areas of your body that are most vulnerable to sprains are your ankles, knees, and wrists. A sprained ankle can occur when your foot turns inward, placing extreme tension on the ligaments of your outer ankle. A sprained knee can be the result of a sudden twist, and a wrist sprain can occur when falling on an outstretched hand.

A twisting force to the lower leg or foot is a common cause of ankle sprains.
Reproduced from The Body Almanac. © American Academy of Orthopaedic Surgeons, 2003.

Sprains are classified by severity:

  • Grade 1 sprain (mild): Slight stretching and some damage to the fibers (fibrils) of the ligament.
  • Grade 2 sprain (moderate): Partial tearing of the ligament. There is abnormal looseness (laxity) in the joint when it is moved in certain ways.
  • Grade 3 sprain (severe): Complete tear of the ligament. This causes significant instability and makes the joint nonfunctional.

While the intensity varies, pain, bruising, swelling, and inflammation are common to all three categories of sprains. Treatment for mild sprains includes RICE and sometimes physical therapy exercises. Moderate sprains often require a period of bracing. The most severe sprains may require surgery to repair torn ligaments.


A strain is an injury to a muscle and/or tendons. Tendons are fibrous cords of tissue that attach muscles to the bone. Strains often occur in your foot, leg (typically the hamstring) or back.

Similar to sprains, a strain may be a simple stretch in your muscle or tendon, or it may be a partial or complete tear in the muscle-and-tendon combination. Typical symptoms of a strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping.

A severe hamstring injury where the tendon has been torn from the bone.

Soccer, football, hockey, boxing, wrestling and other contact sports put athletes at risk for strains, as do sports that feature quick starts, such as hurdling, long jump, and running races. Gymnastics, tennis, rowing, golf and other sports that require extensive gripping, have a high incidence of hand sprains. Elbow strains frequently occur in racquet, throwing, and contact sports.

The recommended treatment for a strain is the same as for a sprain: rest, ice, compression and elevation. This should be followed by simple exercises to relieve pain and restore mobility. Surgery may be required for a more serious tear.

Contusions (Bruises)

A contusion is a bruise caused by a direct blow or repeated blows, crushing underlying muscle fibers and connective tissue without breaking the skin. A contusion can result from falling or jamming the body against a hard surface. The discoloration of the skin is caused by blood pooling around the injury.

Most contusions are mild and respond well with the RICE protocol. If symptoms persist, medical care should be sought to prevent permanent damage to the soft tissues.

Common Overuse Soft-Tissue Injuries


Tiny tears in the Achilles tendon cause it to swell and thicken.

Tendinitis is an inflammation or irritation of a tendon or the covering of a tendon (called a sheath). It is caused by a series of small stresses that repeatedly aggravate the tendon. Symptoms typically include swelling and pain that worsens with activity.

Professional baseball players, swimmers, tennis players, and golfers are susceptible to tendinitis in their shoulder and arms. Soccer and basketball players, runners, and aerobic dancers are prone to tendon inflammation in their legs and feet.

Tendinitis may be treated by rest to eliminate stress, anti-inflammatory medication, steroid injections, splinting, and exercises to correct muscle imbalance and improve flexibility. Persistent inflammation may cause significant damage to the tendon, which may require surgery.


Bursae, are small, jelly-like sacs that are located throughout the body, including around the shoulder, elbow, hip, knee, and heel. They contain a small amount of fluid, and are positioned between bones and soft tissues, acting as cushions to help reduce friction.

Bursitis is inflammation of a bursa. Repeated small stresses and overuse can cause the bursa in the shoulder, elbow, hip, knee or ankle to swell. Many people experience bursitis in association with tendinitis.

Swelling associated with elbow bursitis.

Bursitis can usually be relieved by changes in activity and possibly with anti-inflammatory medication, such as ibuprofen. If swelling and pain do not respond to these measures, your doctor may recommend removing fluid from the bursa and injecting a corticosteroid medication into the bursa. The steroid medication is an anti-inflammatory drug that is stronger than the medication that can be taken by mouth. Corticosteroid injections usually work well to relieve pain and swelling.

Although surgery is rarely necessary for bursitis, if the bursa becomes infected, an operation to drain the fluid from the bursa may be necessary. In addition, if the bursa remains infected or the bursitis returns after all nonsurgical treatments have been tried, your doctor may recommend removal of the bursa.

Removal (excision) of the bursa can be done using a standard incision (open procedure), or as an arthroscopic procedure with small incisions and surgical instruments. Your doctor will talk with you about the best procedure for your medical needs.


Injuries often occur when people suddenly increase the duration, intensity, or frequency of their activities. Many soft-tissue injuries can be prevented through proper conditioning, training, and equipment. Other prevention tips include:

  • Use proper equipment. Replace your athletic shoes as they wear out. Wear comfortable, loose-fitting clothes that let you move freely and are light enough to release body heat.
  • Balanced fitness. Develop a balanced fitness program that incorporates cardiovascular exercise, strength training, and flexibility. Add activities and new exercises cautiously. Whether you have been sedentary or are in good physical shape, do not try to take on too many activities at one time. It is best to add no more than one or two new activities per workout.
  • Warm up. Warm up to prepare to exercise, even before stretching. Run in place for a few minutes, breathe slowly and deeply, or gently rehearse the motions of the exercise to follow. Warming up increases your heart and blood flow rates and loosens up other muscles, tendons, ligaments, and joints.
  • Drink water. Drink enough water to prevent dehydration, heat exhaustion, and heat stroke. Drink 1 pint of water 15 minutes before you start exercising and another pint after you cool down. Have a drink of water every 20 minutes or so while you exercise.
  • Cool down. Make cooling down the final phase of your exercise routine. It should take twice as long as your warm up. Slow your motions and lessen the intensity of your movements for at least 10 minutes before you stop completely. This phase of a safe exercise program should conclude when your skin is dry and you have cooled down.
  • Stretch. Begin stretches slowly and carefully until reaching a point of muscle tension. Hold each stretch for 10 to 20 seconds, then slowly and carefully release it. Inhale before each stretch and exhale as you release. Do each stretch only once. Never stretch to the point of pain, always maintain control, and never bounce on a muscle that is fully stretched.
  • Rest. Schedule regular days off from vigorous exercise and rest when tired. Fatigue and pain are good reasons to not exercise.
  • Avoid the “weekend warrior” syndrome. Try to get at least 30 minutes of moderate physical activity every day. If you are truly pressed for time, you can break it up into 10-minute chunks.

Whether an injury is acute or due to overuse, if you develops symptoms that persist, contact your doctor.

A Ruling Against Obama Would Damage, Not Negate, a Health Care Legacy???

WASHINGTON — The night his administration’s Affordable Care Act passed in 2010, President Obama described the victory the way he hopes historians will: as a “stone firmly laid in the foundation of the American dream.”

But Mr. Obama’s prospects for a legacy of expanding health care coverage in the United States for generations have rarely seemed as uncertain as they do today. The Supreme Courtis expected to rule by the end of the month on a critical provision of the Affordable Care Act — insurance subsidies for millions of Americans — and even Mr. Obama’s closest allies say a decision to invalidate the subsidies would mean years of logistical and political chaos.

“Will that have, in the history books, an impact on the president?” said Kathleen Sebelius, who as secretary of health and human services led the fight in Congress to pass the health care law. “I’m sure. I know Republicans like to focus on how this would be a great blow to the president. But for heaven’s sake, they would have a mess on their hands.”

Continue reading the main story


The Health Care Supreme Court Case: Who Would Be Affected?

A look at the major issues at stake in King v. Burwell and the results of the ruling.


In the Supreme Court case, King v. Burwell, conservatives have challenged the federal government’s right to subsidize premiums for people who signed up for insurance through a federally run health marketplace. If the government loses, more than 6.4 million of those policy holders could see their premiums triple, or worse. Insurance companies could abandon marketplaces across the country. Mr. Obama’s attempt to engineer a private-sector solution to the country’s health insurance crisis could all but collapse.

“It would be a huge, devastating blow to the country,” said Tom Daschle, a former Democratic senator from South Dakota. “It is cataclysmic, from an insurance perspective.”

Health care experts say the elimination of subsidies would collapse the individual health care marketplaces in dozens of states and largely mean the end of the requirement to buy insurance in those places. But other parts of Mr. Obama’s law should survive, including the guarantee of coverage regardless of pre-existing conditions, an expansion of Medicaid, rules allowing young people to be covered by their parents’ insurance until age 26 and requirements that new health plans cover certain preventive care.

Republicans, who control Congress, say they are aware that Americans may look to them for a solution, and could blame them if bickering and gridlock get in the way. But many say they are gleeful that the court may do with a single decision what Republican lawmakers could not accomplish in five years: Cripple one of Mr. Obama’s signature achievements.

“This is the beginning of the end of the Affordable Care Act,” Representative Paul Ryan of Wisconsin, the chairman of the House Ways and Means Committee, said in an interview.

Mr. Ryan said Republicans were preparing legislation that would protect policy holders from losing subsidies until 2017, when Mr. Obama would no longer be in office. At that point, Mr. Ryan said, Republican lawmakers would try to work with the new president to fully dismantle the health care law and replace it with a more conservative approach.

“The key is to get into 2017,” Mr. Ryan said. “That’s why the court ruling is so devastating to him. It will expose this law, and make it certain that Congress will be rewriting this law fully once he’s gone.”

The president’s allies still hold out hope that the court will not undermine the president’s health care law, noting that even some Republicans believe that Congress intended to allow the subsidies when it passed the legislation. Mr. Daschle said he put the odds of the court’s allowing the subsidies to continue at about 50-50.

Mr. Daschle said Mr. Obama had helped bring about other long-term changes to the country’s health care system that would endure even if the court struck down the subsidies. As an example, he said, hospitals are moving away from the fee-for-service model of payment that has helped drive up the cost of health care.

“There’s an inexorable quality to all of this,” Mr. Daschle said. “With each week, each passing month, each year, it becomes an integral part of the health care system.”

Making the changes part of the fabric of the American health care system was the essence of the White House strategy in 2009 and 2010. Mr. Obama and his top aides, led by Rahm Emanuel, who was the White House chief of staff, pushed Congress to pass a health care overhaul quickly to capitalize on Democratic control of Capitol Hill. They also wanted Mr. Obama to have time to put into action whatever law passed.

Over time, they believed, the changes would burrow their way into public expectations of what government should provide, much as Medicare and Social Security, and, in the process, become a major influence on the way Mr. Obama is remembered.

Continue reading the main storyVideo

The Two Americas of Health Care

How King v. Burwell, the latest Supreme Court challenge to the Affordable Care Act, could create two American health care systems divided by access to care.

By Aaron Byrd and Emily B. Hager on  Publish Date February 25, 2015. Watch in Times Video »

“For millions of Americans, the Affordable Care Act is embedded and is a reality,” said David Axelrod, who was a senior adviser to Mr. Obama when the health care law was debated in the first term. “That’s not something to be trifled with.”

Polling suggests that public opinion is split about the health care law. In the latest New York Times/CBS News poll, 47 percent of those surveyed said they approved of the law, while 44 percent said they disapproved.

Still, most Americans do not appear eager to see the law’s most critical benefits overturned by the court. In the survey, 70 percent said they thought that the government should continue to provide financial assistance to buy health insurance. That percentage included nearly nine in 10 Democrats, three-quarters of independents and four in 10 Republicans. If the court rules against the government, nearly two-thirds of those surveyed said, Congress should pass a law to reinstate the subsidies.

Even so, a ruling against the government by the Supreme Court would mean years of uncertainty for the Affordable Care Act.

Mr. Obama would leave office in January 2017 without knowing whether millions of people would remain stuck in the ranks of the uninsured. After years of blocking Republican attempts to tinker with the health care law, he would depart knowing that it remained under attack by his opponents. But it would be up to the next president and Congress to decide whether, and how, to fix it or abandon it altogether.

For the president’s closest allies, that prospect is galling.

Mr. Axelrod, the protector of Mr. Obama’s political brand, said the president was not “sitting there thinking about his legacy.”

“He’s thinking about what’s the best thing for the country,” Mr. Axelrod said.

But he is also a veteran campaign operative who spent much of the previous decade trying to get Mr. Obama into the Oval Office. He said the history books would record the president’s efforts to pass a health care law against tremendous opposition, and the effect that the law has already had on millions of Americans.

“The reality is that people’s lives have been affected in a very positive way,” Mr. Axelrod said. “That’s not a legacy that’s going to be erased easily.”

Ms. Sebelius said she worried most about the people who have been able to afford health insurance for the first time because of the subsidies. Some of those people would have to stop treatment if they suddenly lost their insurance because of the court’s decision.

“That, to me, is what would be so wrenching and heartbreaking,” Ms. Sebelius said. “There are people whose lives had changed forever for the better. I don’t know what then happens to them.”

But Mr. Ryan, who vowed to unwind the Affordable Care Act when he was a vice-presidential candidate in 2012, predicted the court would rule against the law.

“I think they cut corners trying to get this bill into law,” Mr. Ryan said. “Those chickens are coming home to roost.” If the court rules against Mr. Obama, he added, “I think it’s a huge blow to his efforts to create a le

Health Reform: What Changes Are in Store for the Elderly?

After a year of legislative wrangling and premature forecasts of death, historic legislation overhauling the nation’s health insurance system has passed the Congress and been signed into law by President Obama. The measure that finally prevailed, the Patient Protection and Affordable Care Act, is the same legislation the Senate had approved on Christmas Eve of 2009, although it was amended somewhat by a separate “budget reconciliation” measure that President Obama also signed into law.

Because the core health reform measure enacted is the Senate version, much of what we wrote in our earlier article, “The Effects of Health Care Reform on Long-Term Care,” still applies. Just substitute “the newly enacted law” wherever “the Senate bill” appears in the earlier article. The legislation that President Obama signed still contains:

  • The nation’s first publicly funded national long-term care insurance program, the Community Living Assistance Services and Supports (CLASS) Act. Its original sponsor, the late Sen. Edward M. Kennedy, did not live to see one of his legislative dreams enacted into law; [Update: the Department of Health and Human Services has stopped implementing this provision of the law.]
  • A number of provisions aimed at ending Medicaid’s “institutional bias,” which forces elderly and disabled individuals in many states to move to nursing homes;
  • Provisions that will help protect nursing home residents and other long-term care recipients from abuses, and give families of nursing home residents more information about the facilities their loved ones are living in or considering moving to; and
  • The Elder Justice Act, which will establish an “Elder Justice Coordinating Council” and provide federal resources to support state and community efforts to fight elder abuse.

Help for Medicare Recipients and Early Retirees

Of perhaps greatest interest to seniors, the law will eventually close the Medicare Part D coverage gap known as the “doughnut hole.” As most seniors know, the Medicare Part D prescription drug program covers medications up to $2,960 a year (in 2015), and then stops until the beneficiary’s out-of-pocket spending reaches $4,700 in the year, when coverage begins again. Many seniors fall into this “doughnut hole” around Labor Day, at which point they have to pay for the medications out of pocket through the end of the year.

The law starts the process of closing the gap by providing a $250 rebate to Medicare beneficiaries who fall into the doughnut hole in 2010. Then, beginning in 2011 there will be a 50 percent discount on prescription drugs in the gap, and the gap will be closed completely by 2020, with beneficiaries covering only 25 percent of the cost of drugs up until they have spend so much on prescriptions that Medicare’s catastrophic coverage kicks in, at which point copayments drop to 5 percent.

In addition, starting January 1, 2011, Medicare will provide free preventive care: no co-payments and no deductibles for preventive services such as glaucoma screening and diabetes self-management. Also, the legislation increases reimbursements to doctors who provide primary care, increasing access to these services for people with Medicare.

The law provides help for early retirees by creating a temporary re-insurance program that will help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64. Scheduled to run from June 21, 2010 through January 1, 2014, the reinsurance program will pay 80 percent of eligible claim expenses incurred between $15,000 and $90,000.

The law calls for an increased Medicare premium for those individuals earning more than $200,000 a year and married couples whose income exceeds $250,000. The law also applies the Medicare payroll tax to net investment income for couples earning more than $250,000 a year or individuals earning more than $200,000 a year.

Most of the cost savings in the law are in the Medicare program, which has made many seniors fearful that their benefits will be cut. The cost-saving measures do not affect the basic Medicare benefits to which all enrollees are entitled, but they may affect those enrolled in private Medicare Advantage plans. Medicare has been paying insurers who offer these plans more than it spends on average for Medicare beneficiaries. The original idea of Medicare Advantage was to save money by paying them less, the idea being that private insurers could be more efficient than the federal government. The opposite turned out to be the case.

Health care reform will pay the private insurers less, meaning that some will choose not to continue their plans and others will curtail extra benefits they offer enrollees, such as reimbursement for gym membership or free eyeglasses. But the cuts will be gradual, with the largest not beginning until 2015. The law also offers bonuses to efficiently run Advantage plans.

Another provision in the law will cut Medicare reimbursements to nursing homes by about $15 billion over the next decade. While nursing homes get only about 13 percent of their revenue from Medicare, the industry relies on the money to make up for low Medicaid reimbursement.

A combination of the additional revenue and savings are estimated to extend the life of the Medicare Part A trust for an additional 7 to 10 years from its current insolvency date of 2017.

Scammers Vote ‘Yes’ on Health Reform

The new law has also created opportunities for scam artists, some of whom are peddling bogus policies through 1-800 numbers and by going door to door, claiming there’s a limited open-enrollment period to buy health insurance, warns secretary of Health and Human Services Kathleen Sebelius. For more on the fraud alert, click here.

Water and Your Diet..

Find out if you’re getting enough water to keep your metabolism cranking at peak efficiency and your digestive system functioning well.

If you’ve ever tried to lose weight, you’ve probably heard a lot about water and weight loss. Can drinking more water really help you lose weight? The short answer is yes — and no.

If you’re already well hydrated and getting plenty of water, getting more water into your diet probably won’t make a lot of difference. But if you’re going through your days a little — or a lot — dehydrated, as many people are, getting enough water could help.

“In my experience, most people are not aware of how much they’re drinking and are not drinking enough — many, as little as half of what they need,” says Amanda Carlson, RD, director of performance nutrition at Athletes’ Performance, which trains many world-class athletes.

How Water Boosts Metabolism

“Water’s involved in every type of cellular process in your body, and when you’re dehydrated, they all run less efficiently — and that includes your metabolism. Think of it like your car: if you have enough oil and gas, it will run more efficiently. It’s the same with your body.”

“Your metabolism is basically a series of chemical reactions that take place in your body,” says Trent Nessler, PT, DPT, MPT, managing director of Baptist Sports Medicine in Nashville. “Staying hydrated keeps those chemical reactions moving smoothly.” Being even 1% dehydrated can cause a significant drop in metabolism.

Hungry or Thirsty? How Water Helps a Diet

It’s also very difficult for the body to tell the difference between hunger and thirst. So if you’re walking around feeling a gnawing sense of hunger, you might just be dehydrated. Try drinking a glass of water instead of grabbing a snack.

Research has also shown that drinking a glass of water right before a meal helps you to feel more full and eat less. “Many people do find that if they have water before a meal, it’s easier to eat more carefully,” says Renee Melton, MS, RD, LD, director of nutrition for Sensei, a developer of online and mobile weight loss and nutrition programs.

One study, for example, found that people who drank water before meals ate an average of 75 fewer calories at each meal. That doesn’t sound like a lot — but multiply 75 calories by 365 days a year. Even if you only drink water before dinner every day, you’d consume 27,000 fewer calories over the course of the year. That’s almost an eight-pound weight loss.