Little change in overtreatment at doctors' offices

Although some Americans are getting more of beneficial treatments that were underused in the past, including drugs for heart disease, others are still being overtested or overtreated for a range of conditions, according to a new study. Researchers found U.S. doctors' offices made progress on six of nine "quality indicators" for recommended and underused therapies but only scaled back on two of 11 unnecessary and potentially harmful health services. Those findings reflect a growing concern over skyrocketing health care costs - and the realization that doctors and hospitals are going to have to find places where services can be scaled back. "We all know that we need to do something about it, and one component of the high health care costs is the overuse and misuse of therapies and interventions," said Dr. Amir Qaseem, director of clinical policy at the American College of Physicians. It's not about getting rid of services that are too expensive, he told Reuters Health, but evaluating what current tests and treatments may offer little value for certain patients. For example, two overuse indicators included in the new analysis are screening men age 75 and up for prostate cancer and screening women 75 and older for breast cancer. "For men who are getting screened over the age of 75, the likely benefit doesn't happen within a patient's lifetime," Qaseem said, because prostate cancer is often very slow-growing. And that's assuming prostate specific antigen (PSA) tests are beneficial at all. Regardless of a man's age, however, the tests can still lead to invasive biopsies that come with side effects such as a risk of incontinence and impotence. "We really need to start looking at some of these services that may be harmful," added Qaseem, who wasn't involved in the new research. The findings are based on nationally representative studies of adult care in outpatient offices, conducted by the Centers for Disease Control and Prevention. Data came from 79,083 office visits in 1998-1999 and 102,980 visits in 2008-2009. During that span, the use of many recommended therapies improved. For example, 28 percent of people with coronary artery disease were given aspirin in 1998-1999, compared to almost 65 percent a decade later. Likewise, the use of statins more than doubled in those same patients, from 27 percent to 59 percent. In people with diabetes, statin prescriptions increased from 12 percent to 36 percent. However, there was little change in rates of unnecessary and overused services, including some types of cancer screening for older adults or x-rays and urine tests done as part of a general check-up. Two of those overuse indicators improved: cervical cancer screening for women over 65 dropped from 3 percent to 2 percent, and unnecessary antibiotic prescribing for asthma flare-ups fell from 22 percent to 7 percent. On the other hand, rates of prostate cancer screening for older men increased, from between 3 and 4 percent to almost 6 percent, according to findings published Monday in the Archives of Internal Medicine. The lead author on the study from New York's Mount Sinai School of Medicine, Dr. Minal Kale, said the set of quality indicators her team used doesn't necessarily represent all tests and treatments provided in outpatient care. And she added that the overuse of medical services is a complicated issue. "Culturally, there's a lot of resistance to limiting access to health care services because it quickly becomes politicized," Kale told Reuters Health. "The question about overuse really needs to come back to quality. It's about quality of the care that we're delivering to patients." The goal, she said, is to "increase the value and the quality of our health care system while also paying attention to the costs."

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‘Dystextia': Gibberish texts sound stroke alarm

Imagine you were a devoted husband, waiting to hear from your wife about her due date after a visit to the obstetrician, and you saw these on your phone: "every where thinging days nighing" "Some is where!" That's what happened last December to a Boston-area man, who knew that autocorrect - known for its bizarre replacements - was turned off on his 11-week-pregnant wife's phone. You'd probably be tempted to make sure your wife, 25, got to the emergency room. When she did, doctors noted several signs of a stroke, including disorientation, inability to use her right arm and leg properly and some difficulty speaking. A magnetic resonance imaging scan - MRI - revealed that part of the woman's brain wasn't getting enough blood, clinching the diagnosis. Fortunately, her symptoms went away quickly, and the rest of the pregnancy went just fine after she went home from the hospital on low-dose blood thinners. The case, say three doctors from Boston's Harvard Medical School who reported it online today in the Archives of Neurology, suggests that "the growing digital record will likely become an increasingly important means of identifying neurologic disease, particularly in patient populations that rely more heavily on written rather than spoken communication." The authors describe the phenomenon as "dystextia," which is the word used by other doctors in an earlier case involving a migraine, and symptoms of a stroke diagnosed for other reasons. "In her case, the first evidence of language difficulties came from her unintelligible texts," one of the report's authors, Dr. Joshua Klein, told Reuters Health by email. Strokes are rare in women aged 15 to 34, with about 11,000 per year, according to data from the U.S. Centers for Disease Control and Prevention published last year. Dr. Sean Savitz, who directs the stroke program at the University of Texas Health Science Center in Houston, said he has seen a few patients who sent emails suggesting they were having difficulty with language, a condition known as aphasia. Such clues usually come with other information however. In this case, for example, the patient's obstetrician's office later remembered that she had trouble filling out a form. And they might have caught the language difficulty earlier had the woman not had a weak voice, thanks to a recent upper respiratory infection. "So, this case report per se does not indicate to me if dystextia is going to be more common to pick up strokes," Savitz told Reuters Health by email, "but I do think it will be a valuable addition to the collection of information that neurologists should obtain when taking a history." "The main stroke warning signs with respect to texting would be unintelligible language output, or problems reading or comprehending texts," said Klein. "Many smartphones have an ‘autocorrect' function which can introduce erroneous word substitutions, giving the impression of a language disorder." Autocorrect, said Savitz, a professor of neurology, can confuse matters - even for doctors. "I have often joked with my colleagues when using the dictation of the smartphone, that it gives me an aphasia," he said. "Potential for lots of false positives!" SOURCE: Archives of Neurology, online December 24, 2012.

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NRA Takes Fire for Stance on Mental Illness

The National Rifle Association has come under fire by an association of psychiatrists for its characterization of people who commit violent crimes as "monsters," "lunatics" and "insane." The American Psychiatric Association, which represents more than 30,000 mental health professionals, released a statement that expressed its "disappointment" over the gun lobby's use of those terms in the wake of the massacre at the Sandy Hook Elementary school in Newtown, Conn., where Adam Lanza, 20, slaughtered 20 children, six school staffers and his mother. In a news conference last week, NRA CEO Wayne LaPierre repeatedly used the word "monsters" and "insane" to describe people who carry out mass shootings. And during an interview this weekend on "Meet the Press" LaPierre used the word lunatic "as a catchphrase for those who commit violent crimes," the APA said. In his news conference, LaPierre blamed the tragedy on Hollywood, the media, video games and the courts. His remarks also appeared to explicitly scapegoat those with mental illness. "How many more copycats are waiting in the wings for their moment of fame …" LaPierre said. "A dozen more killers? A hundred? More? How can we possibly even guess how many, given our nation's refusal to create an active national database of the mentally ill?" NRA Faces Backlash for Proposing Armed School Guards Watch Video National Rifle Association News Conference Interrupted by Protesters Watch Video Gun Violence Victims, Survivors Share Thoughts After Newtown Massacre Watch Video APA's President Dr. Dilip Jeste said in a statement over the weekend that LaPierre's comments were unfair and inaccurate. "Only 4 to 5 percent of violent crimes are committed by people with mental illness," Jeste said. "About one quarter of all Americans have a mental disorder in any given year, and only a very small percentage of them will ever commit violent crimes." APA's CEO Dr. James H. Scully added that LaPierre's remarks serve to perpetuate the idea that mental illness and evil are one and the same. "This is simply a relic of the past and has no place in our public dialogue. People who are clearly not mentally ill commit violent crimes and perform terrible acts every day. Unfortunately, Mr. LaPierre's statements serve only to increase the stigma around mental illness and further the misconception that those with mental disorders are likely to be dangerous," Scully said. The NRA remains unmoved. Their director of public affairs, Andrew Arulanandam, said he hadn't seen the APA statement and he wouldn't comment specifically on the Newtown shootings because he said he wasn't aware of any official information about Lanza's mental state -- but it wouldn't be unreasonable for anyone evaluating the Newtown killings to conclude the killer was mentally ill. NRA Chief Calls Assault Weapons Ban 'Phony' "Look at other similar shooting incidences. All of these shooters exhibited warning signs. The signs were there and people ignored them," Arulanandam said. "If the media wants to suggest that there was nothing wrong with these people, that's their concern but we believe -- and believe most Americans will agree -- these people were deranged." Bob Carolla, a spokesman for the National Alliance on Mental Illness said he agreed with the APA's statements and also pointed out that it hasn't been established that Lanza suffered from any sort of mental illness. Authorities have nothing but anecdotal information on Lanza's mental state at the time of the shootings.

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Venezuela's Chavez "improves slightly" after surgery: official

Venezuelan President Hugo Chavez's condition has "improved slightly" after a cancer operation in Cuba, the information minister said on Monday, amid doubts over whether the former soldier is in good enough health to continue governing. "The patient has shown a slight improvement in his condition," Venezuelan Information Minister Ernesto Villegas said during a terse televised statement, adding the president has maintained contact with family members. Chavez has not been heard from in two weeks following a fourth operation for an unspecified type of cancer in the pelvic region. The government has said he suffered post-operatory complications including unexpected bleeding and a lung infection, but offered few details about his actual condition. His death, or even his resignation for health reasons, would upend the politics of the South American OPEC nation where his personalized brand of oil-financed socialism has made him a hero to the poor but a pariah to critics who call him a dictator. His allies are now openly discussing the possibility that he may not be back in time to be sworn in for his third six-year term on the constitutionally mandated date of January 10. Opposition leaders say a delay to his taking power would be another signal that Chavez is not in condition to govern and that fresh elections should be called to choose his replacement. They believe they have a better shot against Chavez's anointed successor, Vice President Nicolas Maduro, than against the charismatic president who for 14 years has been nearly invincible at the ballot box. But a constitutional dispute over succession could lead to a messy transition toward a post-Chavez era. Maduro has become the government's main figurehead in the president's absence. His speeches have mimicked Chavez's bombastic style that mixes historical references with acid insults of adversaries. Opposition leader Henrique Capriles, who lost to Chavez in the October presidential vote, slammed Maduro in an interview published on Sunday for failing to seek dialogue with the opposition at a time of political uncertainty. "Maduro is not the one that won the elections, nor is he the leader," Capriles told the local El Universal newspaper. "Because Chavez is absent, this is precisely the time that (Maduro) needs help from people (in the opposition camp)." Chavez has vastly expanded presidential powers and built a near-cult following among millions of poor Venezuelans, who love his feisty language and social welfare projects. The opposition is smarting from this month's governors elections in which Chavez allies won 20 of 23 states. They are trying to keep attention focused on day-to-day problems from rampant crime to power outages.

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Catholic Church urges Irish to oppose abortion law

The head of Ireland's Catholic Church urged followers in his Christmas Day message to lobby against government plans to legalize abortion. Ireland, the only EU member state that currently outlaws the procedure, is preparing legislation that would allow limited access to abortion after the European Court of Human Rights criticized the current regime. The death last month of an Indian woman who was denied an abortion of her dying foetus and later died of blood poisoning has intensified the debate around abortion, which remains a hugely divisive subject in the predominantly Catholic country. "I hope that everyone who believes that the right to life is fundamental will make their voice heard in a reasonable, but forthright, way to their representatives," Cardinal Sean Brady said in a Christmas message on Tuesday. "No government has the right to remove that right from an innocent person." Irish Prime Minister Enda Kenny, a regular Mass goer, is bringing in legislation that would allow a woman to have an abortion if her life was at risk from pregnancy. The country's Supreme Court ruled in 1992 that abortion was permitted when a woman's life was at risk but successive governments have avoided legislating for it because it is so divisive. The death of Savita Halappanavar, who repeatedly asked for an abortion while she was miscarrying in an Irish hospital, highlighted the lack of clarity in Irish law that leaves doctors in a legally risky position. Halappanavar's death re-ignited the abortion debate and prompted large protests by groups both in favor of and against abortion. Kenny and his conservative Fine Gael party have been criticized for tackling the abortion issue and some party members have indicated that they may not be able to back the law. Relations between the Irish government and the once dominant Catholic Church are at an all-time low in the wake of years of clerical sex abuse scandals. Kenny told parliament last year that the Vatican's handling of the scandals had been dominated by "elitism and narcissism" and accused it of trying to cover up the abuse. The speech prompted the Vatican to recall its ambassador, or nuncio, to Ireland. Brady, who has faced calls this year to resign over accusations he failed to warn parents their children were being sexually abused, said in his Christmas message that he wanted relations with government to improve. "My hope is that the year ahead will see the relationship between faith and public life in our country move beyond the sometimes negative, exaggerated caricatures of the past.

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The Real Best Places to Retire in 2012

A blizzard of articles give advice about the best places to retire. They generally recommend fleeing the North and heading for the Sunbelt, to places in the Carolinas, Florida, or Arizona. Occasionally they offer a surprise retirement spot in Iowa or Indiana. Sometimes they even tout retirement locales outside the United States. [See The 10 Best Places to Retire in 2012.] These articles rely on statistics such as the cost of living or winter temperatures. But they miss the most important thing--the human element. Here are the real best places to retire: Stay home. As we get older, moving, making new friends, and acclimatizing ourselves to new surroundings gets more difficult. Don't underestimate the value of your current community. Think long and hard before you cut those connections to go off to get a sunburn. Your hometown likely offers more senior citizen benefits than you think including tax breaks, low-cost transportation, and subsidized meals. We have friends in the outer suburbs of New York who always thought they would retire somewhere warmer. But they finally realized how important their church community was to them and decided to stay put. Now they visit the senior center for a free meal every Thursday night. They walk at the mall two or three mornings a week and stay for coffee with new acquaintances. And they are still active in their church, among the friends they've known for decades. [See The 10 Sunniest Places to Retire.] Move near your children. My brother-in-law spent most of his career working around Pittsburgh, Pa. After he retired, he and his wife gathered together all the brochures and ultimately decided to move to Massachusetts. Their daughter lives outside of Boston and their son is in Rhode Island. They moved from a four-bedroom suburban home to a two-bedroom bungalow in their daughter's town. Their yard is smaller, just right for Grandpa to keep an eye on the grandkids while he relaxes on the patio. They've met new friends through their daughter, and they love their new life, in an area often billed as cold and expensive. Follow your friends. One fellow I know retired to Maryland. Why? His long-time golfing partner retired there a few years earlier. He moved to the same town, joined the same golf club, and soon they were prowling the links together, just like old times. A year later, another friend joined them, who had a relative living nearby, and they all now play golf twice a week. Their wives, who had known each other casually, are now close friends. They started a bridge club, brought in some other women, and from there developed meaningful connections to the community. These couples now feel as though, as one of the women put it, "We've lived here all our lives." [See 10 Places to Retire on Social Security Alone.] Move back home. One friend of mine grew up in El Paso, Texas. She went to college in California, then got married and moved to Washington, D.C. Some 25 years later, her husband died and she felt lost in the big city. She moved back west, to nearby New Mexico, where she started a small business which included some clients in Washington. Now she lives in her beloved mountains and travels to Washington occasionally to see clients. Another woman grew up outside New York. She got married and moved to Oregon and spent most of her 20s and 30s around Portland. Eventually she got divorced and moved first to California, then Arizona, with a year-long stint in Alaska. But when she retired, she felt the pull of Portland, where she still had friends. To her, that was home. And that's where she moved. No matter where you end up in retirement, remember that relationships are more important than the weather. The warmest climate can be found amidst the safety and security of family and friends. Tom Sightings is a former publishing executive who was eased into early retirement in his mid-50s. He lives in the New York area and blogs at Sightings at 60, where he covers health, finance, retirement, and other concerns of baby boomers who realize that somehow they have grown up.

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Baby Boomers Plan Their Retirement Careers

Retirement for the baby boomers is likely to be far different from what their parents experienced. Work will probably be an integral part of everyday life, both to meet financial requirements and to keep busy during an increasing lifespan. Workers approaching retirement should plan now for their pending retirement career. [See 10 Places to Launch a Second Career in Retirement.] Most baby boomers (72 percent) say they plan to keep working in some capacity after retirement, according to a 2010 Del Webb survey. The top reason for working in retirement is to ward off boredom and keep busy, while financial necessity came in second. Other reasons for delaying retirement include self-satisfaction and enjoying the job. Some employees are planning to continue working well into the traditional retirement years. A recent Wells Fargo survey found that 25 percent of middle class Americans say they will need to work until at least 80 to live comfortably in retirement. If seniors will need to work during their retirement years, the nature of the job becomes increasingly important. During our first career we discovered what we are good at, what we like to do, and what we dread doing every day. This knowledge can help us prepare for our second act. Here's how to select a satisfying retirement career: Aim for a job you enjoy. In a down economy you may be forced to take any available job. But if you are lucky enough to be able to consider a job you might actually enjoy, decide what it would look like. What could you do each day that would make you eager to get out of bed each morning, with great expectations of exciting things to be? It is far better to start the day with an optimistic smile versus an anxious moment. [See 5 Social Security Changes Coming in 2012.] Avoid toxic situations. Decide what you would find personally satisfying in a second career and also the tasks you would dread doing. A typical job includes a mix of each, but ideally you want to tip the scale toward what you love. Test drive your dream job. When you were younger, what did you dream of becoming? Although a ballerina or an astronaut might not be realistic now, think back on what it was you always wanted to do. If a certain career field still intrigues you, try to explore opportunities for a retirement career trying it out. Play to your strengths. After several decades in the workforce, you probably already know whether you prefer flexibility or routine, independence or supervision, creativity or clearly defined activity, and risk or assurance. Look for a second career that has the characteristics you find most important in a satisfying job. [See 7 Misconceptions About Retired Life.] Try something new. Try to incorporate something you feel passionate about into your retirement job. Take steps to impact the direction of your retirement career, rather than just letting it happen. Dave Bernard is not yet retired but has begun his due diligence to plan for a satisfying retirement. With a focus on the non-financial aspects of retiring, he shares his discoveries and insights on his blog Retirement-Only the Beginning.

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Why Older Workers are Better Workers

At a time when high unemployment numbers constantly make the headlines, companies can be selective about whom they want to hire. Older workers generally don't make the top of lists of potential job candidates for a variety of reasons, some real and some imagined. But with 10,000 baby boomers reaching the age of 65 each day for the next twenty years, hiring companies would do well to re-evaluate this untapped pool of labor, especially once our economy finally gets back on track. [See Companies with the Most Older Workers.] According to the Age Discrimination in Employment Act, people over the age of 40 are protected against being treated less favorably because of age. As these older workers become a bigger part of the workforce, hiring companies will need to objectively consider the positive and negative aspects of each candidate regardless of age. The good news is that, in many ways, older workers are better workers. Here's why older workers make excellent employees: More direction. Many young people are still struggling to figure out what they want to do for their career and are getting their first exposure to the corporate world. Older workers generally possess a wealth of knowledge and experience gleaned over years of employment, and have a good idea of how to get the job done. Less turnover. Older workers are less likely to job hop than younger employees. They typically have lower turnover and are absent less. [See Older Worker Employment Reaches Record High.] Experience pays off. Many older workers are experienced at the requirements of the job, and know what works and what does not work. This could allow them to get the job done more efficiently or to produce higher quality results. Contrary to popular belief, older employees do not cost employers more than younger workers, according to Peter Cappelli, coauthor of Managing the Older Worker: How to Prepare for the New Organizational Order. Higher wages are not based on age, but on experience, which often benefits the employer to the point that it is worth paying them at a higher level. Understand the culture. Older employees know and live the corporate culture because they have been immersed in it for years. You won't find very many of them ignoring the dress code or posting inappropriate messages on Facebook. Fewer dependents. When it comes to health care coverage, older employees do cost more because they are more likely to have health conditions and seek care. But older employees often no longer have as many dependents to include in the health plan as people with young families, which can actually save the company money. [See 7 Tips for Working for a Younger Boss.] Of course, older workers may need to be accommodated in some ways, especially if the job is physically strenuous. Older employees will be increasingly reporting to younger supervisors, which could cause friction that will need to be addressed. Flexible schedules may also be important to some seniors who want to pursue other interests outside a full-time job.

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Access to Money-Saving Benefits for Those 60 and Older

It's no secret many Americans are facing tough economic times and perhaps no segment more so than those aged 60 and older who are living on reduced or fixed incomes. The National Council on Aging and the National Association of Area Agencies on Aging wants to help connect those individuals with services to help reduce the costs for prescriptions, utilities, food and health care. Aid Funds Available in the Billions of Dollars A news release provided by the NCOA and n4a reveals there are assistance funds of more than $20 billion available to the millions of baby boomers and their seniors who qualify for assistance to reduce or eliminate the cost of necessities such as heat, electricity and basic phone service, plus items and services related to health. Brandy Bauer, spokeswoman for the NCOA, told Reuters that $6.8 billion in benefits remains unclaimed by Medicare recipients who qualify for Medicare Part D Extra Help but have not ever filed for this benefit. Ready Access to Benefits Programs for Seniors The National Council on Aging and the National Association of Area Agencies on Aging have combined their efforts to bring potential benefit recipients and benefit programs together in the You Gave, Now Save program. The intent of the program, as described by Reuters, is to aid the income-eligible of the 57 million Americans who are 60 years old and older, to learn about what benefits are available and provide the information needed to make application. The program provides information for a variety of benefit programs ranging from food assistance to transportation resources to heating and cooling assistance. Other Resources for Seniors and Their Families The You Gave, You Save program is provided in addition to the Eldercare Locator program that puts people in touch with resources in their communities and helps long-distance family members learn what is available in their loved one's community. Another program is the Benefits CheckUp program, a program that touts itself as aiding more than 3 million people accessing benefits worth more than $11 billion in the 10 years it has been in existence. It can be hoped that by getting the information to the people who need it, they will be able to improve their quality of life by being able to afford food and prescription medication. No more having to make choices between the two.

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How health care law affects lives of 7 Americans

CHICAGO (AP) — A father lost his job at a medical device company that is facing a new tax. A young woman got back on her parents' insurance and was able to get surgery for an injury that could have hobbled her. A part-time sales woman stopped putting off a colonoscopy and cancer screenings and saved nearly $3,000 because health plans now must pay for preventive care without co-pays. A business owner received a tax rebate for providing health coverage to her employees. As the U.S. Supreme Court prepares to hear arguments on President Barack Obama's health care overhaul, The Associated Press spoke with a variety of people to hear their experiences so far with the landmark legislation, whose major provisions don't take effect until 2014. Reporters asked: How has the health care law affected your life? Here are snapshots of seven Americans: ___ Name: Michael Esch Home: Warwick, N.Y. Age: 48 Occupation: Former middle manager for medical device company, now working as a hospital purchasing agent. Insurance coverage: Paying out of his own pocket for COBRA insurance through his former company. Esch, a father of three, lost his job in November in a layoff his employer said resulted from President Barack Obama's health care law. Medical device maker Stryker Corp. announced in November it intended to lay off 1,000 workers worldwide to save money ahead of a 2.3 percent tax on medical devices that starts in 2013. The tax on medical devices is meant to help pay for expanding health coverage to uninsured Americans. The Obama administration argues device companies will gain in the long run as more patients become eligible to receive their products because they have insurance. Esch was a middle manager who had worked for Stryker for six years. He helped develop a product known as the Triathlon Knee. Since the layoff, he's taken a salary cut to work as a hospital purchasing agent. He's still looking for a job with another medical device company. He blames the medical device tax for the loss of his job, but he's grateful for the provision in the health care law that will allow his oldest child, now a college sophomore, to stay on his health insurance to age 26. "We tend to forget that for every great idea there is a ripple effect through other sectors of a business," Esch said. Economists say most companies should be able to pass on the bulk of the tax to customers, but the industry says it will squeeze profits and chill investment, hiring and innovation. ___ Name: Glenn Nishimura Home: Little Rock, Ark. Age: 62 Occupation: Consultant to nonprofit groups. Insurance coverage: Uninsured since COBRA coverage from a previous job expired in May of 2009. Nishimura has been uninsured for nearly three years. He lost his health coverage after he left a full-time position with benefits in 2007, thinking he could land another good job. The recession destroyed that plan. He's been denied coverage because of high blood pressure and high blood-sugar levels. A provision in the national health care law gave his state $46 million to insure people like him who've been denied coverage because of pre-existing conditions. But Nishimura said he can't afford the coverage. It would cost him about $6,300 a year in premiums with a $1,000 deductible, meaning he would pay the first $1,000 out of his own pocket before coverage kicks in. He worries about suffering injuries in a car accident or falling ill before he's eligible for Medicare at age 65. "I don't like feeling vulnerable like this," Nishimura said. "I'm completely vulnerable to some catastrophic problem." Nationally, about 50,000 people with pre-existing conditions have signed up for the coverage available through the health care law, fewer than expected. The government has offered new options to encourage more to enroll. In another two years, he may be eligible for subsidies under the law for insurance. ___ Name: Samantha Ames Home: Washington, D.C. Age: 25 Occupation: Law student Insurance coverage: Got back on parents' insurance, thanks to the health care law. As a teenager, Ames was prone to ankle injuries playing catcher on baseball and softball teams. Last April, she tripped over her mini bulldog and badly injured her left ankle. Ultimately she needed surgery that cost her insurer $30,000. But she considers herself lucky. Only a few months before her accident, Ames had been able to get back on her parents' insurance, thanks to a provision of the health care law that lets young adults keep that coverage until they turn 26. Nationally an estimated 2.5 million young people have gotten insurance as a result. Ames says it's unclear if the student health insurance she had been relying on previously would have covered her surgery. In any case, the copayments would have been steep. She would have had to postpone the operation, risking another — potentially crippling — injury. "The fact that I was able to get on their plan is the reason I can walk today," said Ames. "Very rarely have I had something political affect me this personally." ___ Name: Sharon Whalen Home: Springfield, Ill. Age: 59 Occupation: Publisher of a weekly alternative newspaper Insurance coverage: Small group plan. As a co-owner of the Illinois Times, a weekly newspaper, Whalen wants to keep her small staff healthy. So she and her business partner provide them with health insurance and pay half the cost of premiums for their 10 employees. Keeping that employee benefit is getting more and more expensive. The company saw a spike in premium costs after one employee's child had chronic health problems. With costs climbing, the company switched to a managed care plan with higher copays for some services in 2009. Whalen's company also contributes less than it once did to cover the premiums of employees' family members. The health care law brought some relief: a tax credit for small businesses that provide health coverage. The Illinois Times qualified and received a $2,700 tax credit last year. "We see ourselves putting that money right back into the company," Whalen said. Whalen heard about the tax credit from a health care advocacy group, not from her accountant. "I had to practically beg them to look at this," Whalen said. "They weren't familiar with it." The Obama administration has proposed expanding the number of businesses eligible for the credit, and simplifying the paperwork. ___ Name: Melissa Pearson Home: Prineville, Ore. Age: 53 Occupation: Retail sales, part time. Insurance coverage: High-deductible plan purchased on individual market. A few years ago, Pearson's doctor ordered her to have a routine colonoscopy. It's one of several colon cancer screening methods highly recommended for adults ages 50 to 75. Pearson kept putting it off, in part because of the cost. Her high-deductible health insurance plan requires her to pay the first $5,600 out of her pocket each year. She knew the colonoscopy would be expensive and figured she'd be paying. Then she learned that a provision in the health care law requires health plans to cover all costs for preventive care including colon cancer screening — with no out-of-pocket costs to the patient. "That's what made me make the appointment," she said. She also scheduled a mammogram and cervical cancer screening, which also are covered preventive services under the law. In all, she saved nearly $3,000 in out-of-pocket costs last year because of the Affordable Care Act. "I said to my sister, 'Thank you Obamacare," Pearson said. The Obama administration says the Affordable Care Act provided about 54 million Americans with at least one new free preventive service last year through their private health insurance plans. But Pearson is worried that covering preventive services will mean her insurance premiums and her taxes will go up. "It's being paid for by somebody," she reasoned. She recently talked with a student from Norway who told her about the tax levels in that country. "I'm fearful our world will turn into that." ___ Name: David Zoltan Home: Chicago Age: 34 Occupation: Field marketing coordinator for a public relations firm. Insurance coverage: Federally funded health plan for people with pre-existing conditions. Zoltan lost a job and his health insurance during the recession. His diabetes sent him to the emergency room three times when he ran out of insulin during the two years he was uninsured. In 2010, he was one of the first to sign up in Illinois for a new health insurance program for people with pre-existing conditions. The Affordable Care Act set aside $196 million for the state of Illinois to start the program. Zoltan now pays about $1,848 a year for that coverage. The plan has a $2,000 deductible, meaning Zoltan also pays that amount out of pocket before the coverage starts. Zoltan has found work, but his new job doesn't include health benefits, so he'll stay on the federally funded health plan. "As a diabetic, I never again want to be without health insurance," Zoltan said. "Anything is better than not having coverage at all." He is watching the Supreme Court as it considers the law. The requirement that Americans buy health insurance is under constitutional scrutiny. Zoltan believes the individual mandate is needed to spread the risk among the well and the sick, and keep insurance affordable. ___ Name: Carol McKenna Home: Pembroke Pines, Fla. Age: 70 Occupation: Retired. Insurance coverage: Medicare Advantage plan. McKenna and her husband Morty have noticed that Medicare's "doughnut hole" is shrinking. The coverage gap in Medicare's prescription drug program — dubbed the "doughnut hole" — caught Morty in December last year. But once there, he received a 50 percent discount on brand-name drugs and other discounts on generic drugs thanks to Obama's health care law. Last year, he received a $250 rebate check provided by the new law for people in the doughnut hole. Under the health care law, the gap will be gradually phased out by 2020. Warnings about possible cuts to Medicare Advantage plans caused by the health care law haven't come true, Carol McKenna said. Their health plan still includes extra benefits such as fitness center membership. She said she's grown weary of the political debate over the health care law. "I've been following it somewhat. Then it got so convoluted and out of control during the elections that I stopped paying attention," McKenna said. "I don't want to hear it anymore. All they're doing is sniping at each other."

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