Nearly 9 Million People Gained Insurance In Health Marketplace’s First Year

 

Healthcare.gov is shown during open enrollment in 2014 for signups for 2015 health insurance plans. In part due to enrollments using healthcare.gov, the uninsured rate in the U.S. dropped to 10.4 percent

The percentage of Americans without health insurance dropped by nearly three percentage points between 2013 and 2014, according the U.S. Census Bureau, from 13.3 to 10.4 percent. Put another way, 8.8 million more people were insured in 2014 than the year before.

 

The annual study from Census is considered the definitive measure of health insurance, although a change in the way health insurance questions are asked make this year’s report comparable to 2013 but not earlier years.

Census officials, however, point out that a different annual survey that has asked health insurance questions consistently show this to be the biggest drop in the uninsured since at least 2008.

Others say the sizable increase in Americans with insurance – due in large part to the implementation of the federal health law – is unprecedented since the creation of Medicare and Medicaid 50 years ago.

“It’s probably the biggest drop ever,” said Paul Fronstin, director of health research at the Employee Benefit Research Institute, who has been studying the uninsured since 1993.

“For the general population, this is a historic drop,” agreed Diane Rowland, head of the Kaiser Family Foundation’s Commission on Medicaid and the Uninsured. (Kaiser Health News is an editorially independent program of the Foundation.)

More importantly, said Rowland, “the gains are exactly where the biggest problems were,” meaning the largest increases in coverage were in those groups with traditionally the highest rates of uninsurance – younger, working-age adults and people with low and moderate incomes.

Despite the gains, the Census study found that 33 million people are without insurance.

While the gains in insurance coverage were widespread, they were not equal in every category. Not surprisingly, among types of coverage, the biggest increases were in people covered by Medicaid (up 2 percentage points to 62 million people) and people buying their own health plans (up 3.2 percentage points to 14.6 million people). Expanding Medicaid and making private insurance easier to purchase by those without employer coverage were key focuses of the health law.

But the largest single source of health insurance remains that provided by employers. That number held steady at around 55 percent.

The uninsured rate dropped for every age, income and ethnic group and in every state, although, again, some gained more than others.

Those at the lower end of the income scale were more likely to gain insurance than those with more resources. The uninsurance rate for households earning less than $25,000 per year dropped 4.3 percentage points and the rate for those with incomes between $25,000 and $50,000 dropped 5 points. The uninsurance rate for those earning more than $100,000 annually dropped too, but by less than a percentage point. Most of those people, however, were already insured.

Similarly, the uninsured rate for the white non-Hispanic population (the ethnicity most likely to have insurance) dropped by just over 2 percentage points, while the rates for blacks, Asians and Hispanics dropped by more than 4 percentage points each.

Among states, Massachusetts (which began requiring most people to have insurance in 2006) had the lowest rate of people uncovered, at 3.3 percent, while Texas continued to lead the nation with the highest uninsured rate, 19.1 percent.

States that expanded Medicaid, however, saw overall gains in insurance – not just Medicaid – that were larger than those that did not. For example, people with incomes above poverty but less than four times that (most of whom are not eligible for Medicaid) still saw an overall decline in uninsurance of 6.4 percentage points in states that expanded Medicaid, while states that didn’t take that option saw that rate drop by only 4 percentage points.

Rowland suggests that “reflects the push in those states to get people insured, above and beyond (Medicaid) expansion.”

 

https://www.census.gov/content/dam/Census/library/publications/2015/demo/p60-253.pdf

HIV and Aging

Currently, about one quarter of all people living with HIV, about 290,000 people, are aged 55 or over

 

National HIV/AIDS and Aging Awareness Day is a day to reflect on the successes and challenges of aging with HIV. Currently, about one quarter of all people living with HIV, about 290,000 people, are aged 55 or over. Most were infected at younger ages and have benefited from the improving medicines that can make living with HIV more like a traditional chronic disease. Compared with younger people, people over the age of 50 who are living with HIV are more likely to know their HIV status and to be virally suppressed.

Medical management of HV has simplified over the years, however, additional medical conditions associated with aging occur in older people already living with HIV. The management of multiple medical conditions requires awareness of the potential for drug interactions and a coordinated approach to care. As more people live into older ages with HIV, there are other areas that deserve greater awareness and action:

· The possibility of increased HIV transmission among older people. People aged 55 and older represent about 5% of all new HIV infections in the United States. However, as more people age with HIV, transmission may also increase. HIV (and STD) prevention and sexual health information focused on older age groups is key to prevent further transmission.

· The importance of early diagnosis. Persons aged 50 and over accounted for almost one-fifth (18%) of new HIV diagnoses in 2013. Starting antiretroviral medications early in the course of HIV infection and staying on it can protect health and extend life – in some cases, nearly equal to that of someone without HIV. Routine HIV testing through age 65 per US Preventive Services Task Force guidelines, with more frequent testing for those at higher risk, is the best way to detect HIV as early as possible.

· Awareness of the social issues that can accompany living with HIV into older ages. Older people living with HIV often experience stigma and discrimination, which can lead to social isolation, loneliness, depression, minimize health-seeking behaviors, and create concerns with elder care situations.

· The need for caregivers trained to meet the needs of older people living with HIV. Assisted living centers, nursing homes, and home health care providers need caregivers educated in the specifics of caring for people living with HIV and other conditions. Additionally, institutions and providers should strive to create supportive environments free from stigma and discrimination to effectively serve the needs of the varied populations affected by HIV.

Work is underway in many of these areas. CDC offers resources for all people living with HIV through its campaign HIV Treatment Works, and features older people living with HIV in its anti-stigma campaign, Let’s Stop HIV Together. The Department of Health and Human Service’s Administration on Aging features a website with resources on HIV and Aging. All activities support the National HIV/AIDS Strategy’s call for broader HIV education across the lifespan—including among older Americans.

In just the past few years, we have seen the percentage of people living with HIV who are over the age of 65 increase 91% — from 32,000 people in 2007 to 61,200 people in 2012. These numbers will continue to increase as people continue to live longer and more healthily with HIV. This is first and foremost a success. But history will judge us not only on the advances in testing to help people learn of their infection and in medications to keep them healthy, but also in supporting people living with HIV across their lifetimes. National HIV/AIDS and Aging Awareness day draws attention to this need, and it is up to all of us to meet it.

By Jonathan Mermin, M.D., M.P.H., Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention and Dr. Sean Cahill, PhD, Director, Health Policy Research, Fenway Institute

From AIDS.gov

United States Conference On AIDS 2015

http://www.2015usca.org/

We Make the Change!

HIV Prevention

Approximately 15 Floridians become infected with HIV every day. We still have much work to do and, to be successful in the fight, we must do it together. Remember, each of us is part of the solution to end this epidemic.

SYMPTOMS

A wide range of symptoms is associated with HIV/AIDS. Many symptoms are not necessarily due to the breakdown of the immune system, but are the result of opportunistic diseases and infections and their manifestations. Two common manifestations are Pneumocystis Pneumonia (PCP) — a lung disease in which victims experience shortness of breath, a non-productive (dry) cough, anemia, and fever — and Kaposi’s Sarcoma (KS), a type of cancer that manifests itself as grayish-purple skin lesions, lesions on several internal organs, night sweats, and weight loss. Other symptoms associated with the various opportunistic diseases and conditions are chronic headaches, chronic and persistent diarrhea and vomiting, blindness, memory loss, rashes, sores, assorted aches and pains, neurological dysfunction and other manifestations.

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HOW IS HIV TRANSMITTED?

Get the facts about how HIV is transmitted. Become more aware of how you might be putting yourself at risk.

Body Fluids

HIV can live only in certain fluids of the human body. These fluids are blood, semen, vaginal secretions and breast milk. Saliva, sweat, urine and tears do not spread the virus because they do not have enough white blood cells for the virus to grow and survive.

Risk Behaviors

HIV can be transmitted by any type of sexual contact (anal, penis-to-rectum; vaginal, penis-to-vagina; or oral, mouth-to-penis, -vagina, or -rectum), by blood-to-blood contact, including injecting drugs and sharing needles, or by a woman to her baby either before or during birth or through breastfeeding. HIV is not transmitted through any type of casual contact, nor by insects or animals. People are at risk of HIV infection when they participate in behaviors in which the exchange of bodily fluids is possible. Two examples of risky behaviors are having unprotected sex with an infected person and sharing needles.

Unprotected sex

Unprotected sex, or sex without latex or polyurethane condoms, can let HIV enter the blood. Vaginal, anal and oral sex each can transmit HIV. In an infected man, the semen (male sexual fluid) has a high amount of HIV. Semen can pass HIV from one person to another during unprotected vaginal, anal or oral sex. The virus can go through the lining of the vagina, anus or mouth into a person’s bloodstream. In women, vaginal fluids and menstrual blood can pass the virus to another person.

Needle-Sharing

The most efficient means of HIV transmission is blood-to-blood transmission and injecting drugs and sharing needles is the behavior that accounts for the second highest number of reported AIDS cases (behind sexual contact) in the United States. If sufficient amounts of HIV-infected blood get into the body, infection may occur. It may take as little as a few drops for infection to occur. History has shown exposure of infected blood to intact skin (no open sores or lesions) does not transmit the virus.

If a person injects drugs either intravenously (into the vein) or intramuscularly (into the muscle) and shares needles, they are engaging in a behavior that puts them at great risk of transmitting or acquiring HIV.

Any type of needle sharing may transmit HIV. If an infected body builder injects anabolic steroids and shares the needle with someone else, the virus may be transmitted. Sharing tattoo needles or sharing needles for ear or body piercing could be a means of transmitting HIV. Intravenous infection could occur among seniors who are diabetic and share insulin needles.

Breast Feeding

The risk of transmission from mother to child through breastfeeding is present due to the high concentration of HIV in breast milk. Without treatment, an estimated one in every seven infants breast-fed by an HIV-positive mother becomes infected through breast milk.

Blood Transfusions

Since 1985, all donated blood and blood products are screened for HIV. The risk of HIV infection through a blood transfusion is almost zero. Donating blood poses no risk because blood is drawn using sterile needles that have never been used.

Substance Use

The use of drugs and alcohol continues to be prevalent in many communities and is linked to risk factors for HIV infection and other STDs. Substance use can increase the risk for HIV transmission through the tendency toward risky sexual behaviors while under the influence and through sharing needles or other injection equipment.

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WHO IS MOST AT RISK?

HIV risk factors are the same for everyone, but some populations are more affected than others (see the data here):

Racial/Ethnic Groups

In Florida, African American and Hispanic populations are disproportionately affected. Social and economic factors including racism, poverty, lack of access to health care, and geographic region are barriers to receiving HIV prevention services. African American and Hispanic men are more likely than white men to be given a diagnosis of HIV infection in the late stages of infection, often when they already have AIDS, suggesting that they are not accessing testing or health care services through which HIV infection could be diagnosed at an earlier stage.

Men Who Have Sex With Men (MSM)

MSM are members of all communities, all races and ethnicities, and all strata of society. Social and economic factors, including racism, homophobia, poverty, geographic region and lack of access to health care, are barriers to receiving HIV prevention services, particularly for MSM of minority races or ethnicities. Sexual risk factors account for most HIV infections in MSM. Not using a condom during anal sex continues to be a significant threat to the health of MSM.

Substance Users

Behaviors that may accompany drug use can put people at risk for HIV. For example, trading sex for drugs or for money to buy drugs increases the number of sexual partners and the risk of infection. Similarly, heavy alcohol consumption may cause a person to lose inhibitions and engage in unprotected sexual contact with an infected person and transmission could occur. Judgment is often impaired during inebriation and any measures to prevent the transmission of HIV by the individual may be compromised.

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HOW CAN I REDUCE MY RISK?

Protect yourself from HIV infection. Find out how you can make changes in your lifestyle to reduce your risk.

Abstinence

Abstinence from sexual activity is the only sure way to not become infected through sexual contact. If a person is not sexually active (through oral, anal or vaginal contact), there is virtually no chance of contracting HIV or any STD through sexual activity.

Monogamy

Having sex with only one uninfected partner is a way to be sexually active and not risk infection with HIV. Mutual monogamy means that both partners in a relationship are only having sex with each other.

Condoms

Condoms are an important tool in preventing the spread of HIV. When used properly, condoms create a barrier that prevents the virus from spreading from an infected individual to someone else. Latex condoms are approximately 90 percent effective at preventing pregnancy and the passage of almost all STDs, including HIV. Most often, human error causes condoms to fail. This figure would be about 98-99 percent if everyone who used condoms used them correctly. Polyurethane condoms and female condoms are also highly effective.

Condoms may be obtained free of charge at any county health department in the state of Florida. Local AIDS services organizations and other community-based organizations also distribute free condoms. To find the nearest location where free condoms are available, call the Florida HIV/AIDS Hotline.

Clean Needles

If an injecting drug user is sharing needles, needles and syringes must be cleaned. Ordinary household bleach drawn into the needle and syringe will inactivate HIV. The bleach must be drawn into the syringe, shaken, and squirted out. This process must be completed three times. Then, water must be drawn in, shaken, and squirted to thoroughly rinse out the bleach. This process should also be completed three times since injecting bleach into the veins can be more deadly than HIV.

PrEP and PEP

PrEP (Pre-Exposure Prophylaxis) is a comprehensive HIV prevention strategy that involves the daily use of antiretroviral medications to reduce the risk of HIV infection in HIV-negative individuals. In July 2012, the US Food and Drug Administration approved the use of Truvada (TDF/FTC) for use as PrEP in HIV prevention in sexually active HIV–negative individuals.  PrEP is used in conjunction with other prevention methods to reduce the risk of infection. Learn more about PrEP by clicking here.

Post Exposure Prophylaxis (PEP) involves taking antiretroviral medications as soon as possible after a potential exposure to HIV to reduce the likelihood of HIV infection. There are two types of PEP: 1) occupational PEP, or an exposure that happens in the workplace (such as a needle stick in a healthcare setting), and 2) non-occupational PEP (nPEP), or when someone is potentially exposed to HIV through sexual intercourse or injection drug use.

To be effective, PEP must begin with 72 hours of exposure and consists of 2-3 antiretroviral medications that must be taken for 28 days. A physician must determine what treatment is appropriate based on the nature of the exposure. Starting PEP after a potential exposure does not guarantee that someone exposed to HIV will not become infected.

Avoid Breast Feeding

Because there are documented cases showing that HIV can be transmitted from mother to infant through breastfeeding, HIV-positive women are counseled to avoid breastfeeding. If the mother does not want to feed her baby formula, another option is locating a milk bank (an organization that collects donated breast milk and distributes it). For more information on this option, look for the Human Milk Banking Association of North America, Inc.

Universal Precautions

The observation of universal precautions involves the assumption that any patient could be infected with HIV and/or hepatitis and the responsibility to take appropriate precautions. Universal precautions include such practices as hand washing, the use of protective barriers, proper disposal of needles, and cleaning and disinfecting spills. Health care workers must take precautions when working with the body fluids of others. Hands should be washed properly and frequently.

Latex or plastic gloves, goggles, masks, and protective aprons should be worn during appropriate times and procedures to reduce the risk of exposure of skin and mucous membranes. Needles used for the injection of medicines or the drawing of blood should never be recapped or manipulated by hand in any way.

All needles should be disposed of properly in puncture-proof containers. Some healthcare workers have reported contracting HIV through accidental needle sticks from recapping used needles. When cleaning and disinfecting spills, visible material should be removed with disposable towels and the area decontaminated with a 1:10 solution of bleach and water. If universal precautions are followed at all times, infections are not likely to be transmitted in the health care setting.

Avoid Substance Use

Substance use does not necessarily put people at risk for HIV directly; however, judgment is often impaired during inebriation and any measures to prevent the transmission of HIV by the individual may be compromised.

S e x E d i s H I V P r e v e n t i o n : S u p p o r t Q u a l i t y A d o l e s c e n t

Quality sex education is a critical tool in securing lifelong sexual health, preventing HIV, other sexually

transmitted infections (STIs), and unintended pregnancies. People of all ages, and particularly our nation’s

young people, have the need for, and the right to, sexual health information to help secure their lifelong

health and well-being.

Young people under the age of 25 accounted for 1 in 5 new HIV infections in 2012.

HIV infection rates are increasing among young people, particularly among young men who have sex with

men. Further, young people under age 25 accounted for 68% of all chlamydia cases in 2013. In fact, half of

the nearly 20 million estimated new STIs each year in the U.S. occur among people ages 15–24. While the

unintended teen pregnancy and birth rates are at a historic low, disparities persist and the U.S. continues to

have the highest rates among comparable countries. ese ndings and more, including surveys indicating

that 10% of high school students experience partner violence and/or sexual assault, demonstrate an imminent

need for continued and increased investment in adolescent sexual health promotion e orts and expansion

of quality comprehensive sexuality education (CSE).

Congress’ Opportunity

Congress has the opportunity to prevent HIV among young people, support adolescent sexual health, and

advance comprehensive sexuality education in the U.S. through the following actions:

Support at least level funding for the Teen Pregnancy Prevention Program (TPPP) and the

Division of Adolescent and School Health (DASH) in FY 2016.

Eliminate funding for abstinence-only-until-marriage (AOUM) programs by repealing the

Title V Sec. 510 Abstinence “Education” program and end funding for the Competitive Absti

nence “Education” (CAE) grant program.

Co-sponsor the Real Education for Healthy Youth Act (REHYA).

Support Adolescent Sexual Health Promotion Programs

Congress provides funding for evidence-based, medically accurate, and age-appropriate sexual health education

programs through the authorized Personal Responsibility Education Program (PREP) and two annually

funded programs, TPPP and the Centers for Disease Control and Prevention’s (CDC) DASH. While not

strictly supporting CSE, TPPP provides critical sexual health information to young people through public

and private entities and community- and faith-based organizations. DASH provides invaluable assistance in

assuring the quality of sexual health education provided in our nation’s schools. In FY 2016, continued funding

for TPPP at least at the current level of $101 million and $6.8 million in evaluation funds, and at least

level funding of $32 million for DASH is imperative. Funding at least at current levels will help ensure that

existing quality sex education programs are available to equip young people with the information and skills

they need to make informed and healthy decisions about their lifelong sexual health.

BRIEFING

September 8-9, 2015

Marriot, DC

2015

H I V ACTION DAY

Evidence-based Criteria

To ensure that federally-funded adolescent sexual health promotion programs are e ective and uphold the rights of young people,

programs should undergo a multi-pronged review to ensure they not only improve health outcomes, but are also medically accurate

and adhere to content standards addressing a range of human sexuality topics. is assessment should occur before a program

is promoted in any way by a federal agency.

Content by the Sexuality Information and Education Council of the U.S. (SIECUS)

Eliminate Federal Abstinence-Only-Until-Marriage Programs

Since 1982, more than $1.8 billion in federal dollars has been spent on incomplete, ine ective, and shaming AOUM programs.

While these funding streams have been reduced over the last four years, $55 million was allocated for the Title V Sec 510 AOUM

program and the CAE grant program in FY 2015. Both programs must adhere to a strict denition of “abstinence education”

resulting in the prohibition of teaching young people about the benets of condoms and contraception and failing to respond to

the needs of young people who are already sexually active, survivors of sexual abuse, and/or engaged in same-sex relationships.

Continued funding of these programs not only ignores the advice of experts and years of studies demonstrating such programs’

ine ective, but also undermines the wishes and preferences of the majority of parents in the U.S. who support CSE. ,

What is Comprehensive Sex Education?

Quality CSE provides evidence-based, medically accurate, and developmentally appropriate sexual health

information to address the physical, mental, emotional, and social dimensions of human sexuality for all

young people. Taught by trained educators throughout students’ school years, CSE includes information and

skill development related to a range of topics addressing human development, relationships, personal skills,

sexual behavior including abstinence, sexual health, and society and culture. CSE provides adolescents with

the essential knowledge and critical skills needed to lead sexually healthy lives. Comprehensive programs are

e ective in helping young people delay sexual activity and in increasing contraceptive use when they do become

sexually active. Professional health organizations and parents agree that young people should receive

CSE. Despite the need, evidence, and support for CSE, there is no dedicated federal funding.

Co-sponsor Comprehensive Sex Education Legislation

e Real Education for Healthy Youth Act (REHYA), HR 1706, was introduced by Rep. Barbara Lee (DCA)

in March 2015 and will be introduced by Sen. Cory Booker (D-NJ) later this year. It builds on existing

federal programs by setting forth a policy vision for CSE, providing young people with the information and

skills they need to make informed and healthy decisions expanding beyond a focus on disease and pregnancy

prevention. e legislation outlines federal funding requirements for new initiatives for adolescents; young

people in institutions of higher education; establishes a pre- and in-service teacher training program for K-12

sex educators; and amends current federal laws to enable LGBT inclusive education and allow contraceptive

availability in schools.

Additionally, REHYA would prohibit the use of federal funds for programs that withhold life-saving information

about sexuality-related topics, including HIV; are medically inaccurate; promote gender stereotypes; are

insensitive or unresponsive to the needs of sexually active or LGBTQ youth, or survivors of sexual abuse or

assault; or are inconsistent with the ethical imperatives of medicine and public health.