Health Insurance Exchanges: Health Insurance “Navigators” and In-Person Assistance

The 2010 Patient Protection and Affordable Care Act (ACA, P.L. 111-148) allows certain individuals and small businesses to buy health insurance through state exchanges, beginning on October 1, 2013. The exchanges are not themselves insurers, but rather are special marketplaces where insurance firms may sell health policies that meet set, federal guidelines. As of September 2013, 16 states and the District of Columbia had secured Department of Health and Human Services (HHS) approval to create their own exchanges, 7 to enter into partnership exchanges, 26 to have federally facilitated exchanges, and 1 to have a state-based Small Business Health Options Program (SHOP)/federally facilitated individual exchange. An estimated 24 million individuals are expected to secure coverage through the exchanges by 2022. The ACA requires exchanges to perform outreach to help consumers and small businesses make informed decisions about their insurance options, including the creation of “navigator” programs. Navigators are to carry out public education activities; provide information to prospective enrollees about insurance options and federal assistance; and examine enrollees’ eligibility for other federal or state health care programs, such as Medicaid. Navigators may assist consumers in comparing insurance plans, but may not determine their eligibility for subsidies or enroll them in plans—functions that are left to the exchanges. A variety of organizations may become navigators, including labor unions, trade associations, chambers of commerce, and other entities. Navigators may not be health insurers or take compensation from insurers for selling health policies. Navigators will be required to have 20-30 hours of training on consumer privacy, exchanged-based insurance offerings, and other issues. HHS in August 2013 allocated $67 million in 12-month grants for navigators at federally facilitated and partnership exchanges. In addition, HHS has determined that state-based exchanges may use ACA exchange establishment funds to create parallel, in-person, or non-navigator, assistance programs that perform the same function as navigators. Exchanges must also certify “certified application counselors” to help with outreach and enrollment, though no new ACA funds are available for such programs. Consumers and small businesses may continue to use insurance brokers and agents, including web-based brokers, to compare and buy coverage, both on and off the exchanges. Brokers and agents are licensed by the states, and are generally paid on a commission basis by insurance companies. While brokers and agents may choose to become navigators, they may not accept compensation from health insurance companies in that role. Consumers may also purchase policies directly from health insurers. Outside non-profit groups and businesses, such as insurers, are launching their own separate efforts to educate consumers about the ACA and the process of applying for qualified health plans (QHP) and other programs. Some lawmakers, agents, and brokers have raised questions about the navigator and other assistance programs. Issues include whether navigators will have sufficient training and whether HHS regulations provide sufficiently stringent consumer and privacy safeguards. A number of states have passed legislation to further regulate navigators, including requiring navigators to be licensed and to be liable for financial losses due to their advice. HHS has determined that the ACA gives states authority to set additional standards, so long as they do not prevent implementation of Title I of the law, which includes the exchanges and navigator program. This report describes exchange outreach programs, the role of brokers, agents and insurers, and emerging issues regarding consumer outreach assistance

The U.S. Newspaper Industry in Transition

[Excerpt] The U.S. newspaper industry is suffering through what could be its worst financial crisis since the Great Depression. Advertising revenues are plummeting due to the severe economic downturn, while readership habits are changing as consumers turn to the Internet for free news and information. Some major newspaper chains are burdened by heavy debt loads. In the past year, seven major newspaper chains have declared bankruptcy, several big city papers have shut down, and many have laid off reporters and editors, imposed pay reductions, cut the size of the physical newspaper, or turned to Web-only publication. As the problems intensify, there are growing concerns that the rapid decline of the newspaper industry will impact civic and social life. Already there are fewer newspaper reporters covering state capitols and city halls, while the number of states with newspapers covering Congress full-time has dwindled to 23 from the most recent peak of 35 in 1985. As old-style, print newspapers decline, new journalism startups are developing around the country, aided by low entry costs on the Internet. The emerging ventures hold promise but do not have the experience, resources, and reach of shrinking mainstream newspapers. Congress has begun debating whether the financial problems in the newspaper industry pose a public policy issue that warrants federal action. Whether a congressional response to the current turmoil is justified may depend on the current causes of the crisis. If the causes are related to significant technological shifts (the Internet, smart phones and electronic readers) or societal changes that are disruptive to established business models and means of news dissemination, the policy options may be quite limited, especially if new models of reporting (and, equally important, advertising) are beginning to emerge. Governmental policy actions to bolster existing businesses could stall or retard such a shift. In this case, policymakers might stand back and allow the market to realign news gathering and delivery, as it has many times in the past. If, on the other hand, the current crisis is related to the struggle of some major newspapers to survive the current recession, possible policy options to ensure the continuing availability of in-depth local and national news coverage by newspapers might include providing tax breaks, relaxing antitrust policy, tightening copyright law, providing general support for the practice of journalism by increasing funding for the Corporation for Public Broadcasting (CPB) or similar public programs, or helping newspapers reorganize as nonprofit organizations. Policymakers may also determine that some set of measures could ease the combination of social and technological transition and the recession-related financial distress of the industry

A SIMPLE MODEL OF VOLUNTARY VS MANDATORY LABELLING OF GMOS

We consider the welfare impact of the mandatory and voluntary labelling to inform consumers on GMOs content in foods. With a model of vertical differentiation in competitive markets, we evaluate the effects on price equilibrium and welfare levels. We find that the mandatory labelling scheme would be optimal in those countries with more GMO-averse consumers and no-GMOs practices producers. Voluntary labelling would instead optimally be chosen in those countries where producers are using GMOs and consumers are more concerned about the costs savings resulting in this technology adoption.Research and Development/Tech Change/Emerging Technologies,

Functional morphology of the primary olfactory centers in the brain of the hermit crab Coenobita clypeatus (Anomala, Coenobitidae)

Terrestrial hermit crabs of the genus Coenobita display strong behavioral responses to volatile odors and are attracted by chemical cues of various potential food sources. Several aspects of their sense of aerial olfaction have been explored in recent years including behavioral aspects and structure of their peripheral and central olfactory pathway. Here, we use classical histological methods and immunohistochemistry against the neuropeptides orcokinin and allatostatin as well as synaptic proteins and serotonin to provide insights into the functional organization of their primary olfactory centers in the brain, the paired olfactory lobes. Our results show that orcokinin is present in the axons of olfactory sensory neurons, which target the olfactory lobe. Orcokinin is also present in a population of local olfactory interneurons, which may relay lateral inhibition across the array of olfactory glomeruli within the lobes. Extensive lateral connections of the glomeruli were also visualized using the histological silver impregnation method according to Holmes-Blest. This technique also revealed the structural organization of the output pathway of the olfactory system, the olfactory projection neurons, the axons of which target the lateral protocerebrum. Within the lobes, the course of their axons seems to be reorganized in an axon-sorting zone before they exit the system. Together with previous results, we combine our findings into a model on the functional organization of the olfactory system in these animals

Detection of blood aspiration in deadly head gunshots comparing postmortem computed tomography (PMCT) and autopsy

BACKGROUND: The aim of our study was to analyze the reliability of postmortem computed tomography (PMCT) versus autopsy in detecting signs of blood aspiration in a distinct group of patients following deadly head, mouth or floor of mouth gunshot injuries. METHODS: In this study, in 41 cases PMCT was compared to autopsy reports, the gold standard of postmortem exams, regarding detection of blood aspiration. PMCT was evaluated for the presence and level of typical signs of blood aspiration in the major airways and lung using a semi-quantitative scale ranging from level 0 (no aspiration) to 3 (significant aspiration) also taking density values of the described potential aspiratory changes into account. RESULTS: Overall, in 29 (70.7%) of 41 enrolled cases PMCT and autopsy revealed the same level of aspiration. A difference of one level between PMCT and autopsy resulted for 5 (12.2%) of the remaining 12 cases. More than one level difference between both methods resulted for 7 cases (17.2%). Autopsy described no signs of aspiration in 10 cases, compared to 31 cases with reported blood aspiration. In contrast, PMCT revealed no signs of blood aspiration in 15 cases whereas 26 cases were rated as positive for signs of aspiration in the major airways. In 18 of these 26 cases considered positive for blood aspiration by autopsy and PMCT, clear signs of aspiration signs were also described bilaterally by both methods. CONCLUSIONS: The presented study provides evidence for the assumption that PMCT seems to be helpful in the detection of blood aspiration in cases of deadly head gunshots. In conclusion, it seems reasonable to suggest performing PMCT additionally to traditional postmortem exams in cases of suspected aspiration to rule out false-negative cases and to possibly allow for a more detailed and rather evidence based examination reconnoitering the cause of death. However, the adequate use of PMCT in this context needs further evaluation and the definition of an objective scale for aspiration detection on PMCT needs to be established in future studies

Three-dimensional metamaterials with an ultra-high effective refractive index over broad bandwidth

The authors introduce a general mechanism, based on electrostatic and magnetostatic considerations, for designing three-dimensional isotopic metamaterials that possess an enhanced refractive index over an extremely large frequency range. The mechanism allows nearly independent control of effective electric permittivity and magnetic permeability without the use of resonant elements

Photon Conserving Radiative Transfer around Point Sources in multi-dimensional Numerical Cosmology

Many questions in physical cosmology regarding the thermal and ionization history of the intergalactic medium are now successfully studied with the help of cosmological hydrodynamical simulations. Here we present a numerical method that solves the radiative transfer around point sources within a three dimensional cartesian grid. The method is energy conserving independently of resolution: this ensures the correct propagation speeds of ionization fronts. We describe the details of the algorithm, and compute as first numerical application the ionized region surrounding a mini-quasar in a cosmological density field at z=7.Comment: 5 pages, 4 figures, submitted to ApJ

Manoeuvring simulation on the bridge for predicting motion of real ships and as training tool in ship handling simulators

International sea transport has growing rapidly dur-ing the period of the last decade. Ships became larg-er and wider and its container capacity is still in-creasing to 12.000 TEU and even more. To navigat

Age and gender as determinants of the bone quality of the greater tuberosity: A HR-pQCT cadaver study

Background: Age-dependent trabecular changes of the humeral head might weaken the fixation of suture anchors used for rotator cuff (RC) repair. This might lead to suture anchor loosening and thus compromise the integrity of the repair. The aim of this study was to analyze whether the trabecular microstructure within the RC footprint is influenced by age, gender or handedness. Methods: Axial HR-pQCT scans (Scanco Medical) of 64 freshly frozen cadaveric human humeral head specimens (age 72.3 +/- 17.4 years) were analyzed to determine the bone volume-to-total volume ratio (BV/TV), trabecular thickness (Trab Th), trabecular number (Trab N) and connectivity density (Conn Dens). Within the RC footprint, 2 volumes of interest (VOI), posteromedial (PM) and anterolateral (AL) and one control VOI in the subarticular bone (SC) were set. Results: The highest BV/TV was found in SC: 0.22 +/- 0.06% vs. PM: 0.04 +/- 0.05% vs. AL: 0.02 +/- 0.04%; p < 0.05. Trab Th accounted for 0.26 +/- 0.05 mu m in SC, 0.23 +/- 0.09 mu m in AL and 0.21 +/- 0.05 mu m in PM. In parallel, Trab N and Conn Dens were found to be the highest in SC. Gender analysis yielded higher values for BV/TV, Trab Th, Trab N and Conn Dens for PM in males compared to females (p < 0.05). There were no significant findings when comparing both sides. We furthermore found a strong inverse correlation between age and BV/TV, which was more pronounced in the female specimens (r = -0.72, p < 0.00001). Conclusions: The presented microarchitectural data allow for future subtle biomechanical testing comprising knowledge on age-and sex-related changes of the tuberosities of the humeral head. Furthermore, the insights on the trabecular structure of the humeral head of the elderly may lead to the development of new fixation materials in bone with inferior bone quality