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Friday, February 20, 2015

Measles Outbreak-What It Means When Your Neighbors Don't Vaccinate

Outbreak in Preventable Childhood Diseases On the Rise in the United States
The measles outbreak in the nation has been on the rise for the past two years, but is nearly at epidemic proportions now.  There are 141 cases of measles in 17 states so far in 2015. This chart from the CDC shows the states which have the most outbreaks of measles.
2015 measles cases in the U.S., January 1 to February 13, 2015. Map of the U.S. indicates in shades of light to dark blue the number of cases. Fourteen states (Colorado, Delaware, Michigan, Minnesota, Nebraska, Nevada, New Jersey, New York, Oregon, Pennsylvania, South Dakota, Texas, Utah, and Washington ) and the District of Columbia have 1 to 4 cases (. One state (Arizona) has 5 to 9 cases. One state (Illinois) has 10 to 19 cases and one state (California) has 20 or more cases. These are provisional data reported to CDC’s National Center for Immunization and Respiratory Diseases.
 Measles, is a preventable childhood disease for which an immunization (a shot) is usually given to a child when the child reaches nineteen to thirty-five months of age. Measles causes red spots, fever, and in some cases can result in death. This article reviews changes in childhood immunization patterns, which were reported for all fifty states in Unraveling U.S. Healthcare-A Personal Guide, published in 2013.  Information is drawn from the U.S. Centers for Disease Control and Prevention and is inclusive of 2013 calendar year data.

In 2011, the national immunization rate for children between the ages of nineteen and thirty-five months was 83.34% for all recommended childhood vaccinations. In 2013, the immunization rates for the same age-group of children and the same vaccines had dropped to 83.07%.
 Here are the states with the lowest rate of immunization for these diseases as of  the end of the reporting year for 2013, as compared to the national average. As you can see, the western states do poorly for immunization compliance, as reported in my 2013 health scorecards. The one bright spot is Utah, which matches the national average for the top three vaccines. The outlier in the group is Vermont, which has achieved the dubious designation as the state with the lowest rate of childhood immunizations. And though much of the country seems to ignore the District of Columbia, seat of our nation's capitol, it has a better vaccination rate than the national average, at 86.7% penetration versus 83.07%. Here is information from the table, showing the worst states for immunizing their children:

Children's Health Scorecard-2013 National Average
Oregon Montana Wyoming New Mexico California Colorado Alaska Vermont
Ranking 44 45 46 47 48 49 50 51
DTaP 83.10
83.80 79.00 80.90 79.80 83.10 81.20 75.50 85.80
Hep B 74.20
66.80 73.90 67.00 67.50 70.30 60.20 59.40 44.80
MMR 91.90
89.40 87.30 89.00 89.10 80.70 86.00 90.50 91.20
Average Rate 83.07
80.00 80.07 78.97 78.80 78.03 75.80 75.13 73.93

-3.07 -3.00 -4.10 -4.27 -5.03 -7.27 -7.93 -9.13
Notes: Negative number means performance is worse than the national average.
Immunization rate is for Heb B only.
Immunization rates are from the Centers for Disease Control for 2013 year
In short, this is the reason there are large outbreaks of childhood diseases now. An immunization is a preventive dose to activate the body's immune system to the disease vector. In order to have adequate protection for a population, which means a community, a school, a state, the majority of the population has to become immunized. In the United States, especially on the west coast, we are in danger of losing our herd immunity, which is a scientific term that means the actions of a significant minority can imperil the entire population. The standards for public health in the United States and all developed nations are based on scientific data, using gold-standard studies and analysis, not spurious opinions of the uniformed in social media. The recommended immunizations for children in the above age-group are as follows:
  • Diptheria, Pertussis, and Polio- Pertussis is known as whooping cough and there has been an increase in preventable childhood deaths from this recently as well. Polio of course, causes paralysis and shortened life expectancy and was thought to have been eradicated in the U.S., but thanks to the actions of a minority, this may no longer be the case. Diptheria is a respiratory disease.
  • Measles, Mumps, & Rubella-Measles is an infectious disease causing fever and rash. Mumps is a disease of the salivary glands, causing swelling, fever, and muscle aches. Rubella, also known as German Measles can cause incurable illness for pregnant women, and significantly increases the chance of miscarriage.
  • Influenza-This is a respiratory disease which can and does cause deaths in infants and others whom have immune deficiencies.
  • Hepatitis B-This is a  blood disease which can damage the liver; is transmitted through bodily fluids, and can  be passed from mother to child.
  • Varicella or chicken pox-This is a blister-like rash, fever, and can result in death for those with compromised immune systems.
In The Russell Guide for Diabetics, I share information about the science and the reality of childhood diseases. A 2003 Italian study,  found that early childhood exposure to two diseases damaged the immune system and was significantly linked to causation of Type 1 or juvenile diabetes. Here is an excerpt from my book explaining the findings:

In 2003, a population-based case-control study in Italy, published results which found that childhood exposure to two infections significantly increased the likelihood of a child contracting Type I Diabetes. Infections which were reviewed in the study included; pertussis (whooping cough), varicella (chicken pox), rubella, parotitis, and morbilli.[1] Here are the findings of the study:
1.      The statistically significant finding with no confounding variables,  showed that children in the Abruzzo region of Italy who were exposed to two of the childhood viruses listed, had a higher incidence of Type I Diabetes compared to the population who had been exposed to a single childhood infection.
2.      Children who had been exposed to only one of the listed childhood infections did not show an increased incidence of contracting Type I Diabetes.
3.      Childhood immunizations were also analyzed as risk factors for contracting Type I Diabetes and there was no statistical increase shown in the incidence of juvenile diabetes for the immunized children.
4.      However, for children who had received the pertussis (whooping cough) and MMR (measles, mumps, and rubella) vaccinations, a significant decrease was found in the contraction of childhood Diabetes.

 My brother, Russell was diagnosed with Type 1  Diabetes when he was three years old, three months after his exposure to chicken pox. He had also been exposed to mumps within the year, by his school-age siblings (including moi). Unfortunately, this event was due to the fact immunizations were typically provided through the school at the time of enrollment, so children younger than school age were at risk. Russell died at 42 years of age, following multiple organ transplants, and amputations all related to Type 1 Diabetes.

To all parents who think they are "boosting their child's immune system" by avoiding immunizations, do take the long term view and consider all adverse consequences. This article of course, is written for those whom do base their decisions on scientific evidence. Considering the low-level of science readiness in our national population, as compared to other countries, perhaps this issue will ultimately be decided through tort action in the courts. The CDC clearly states these immunizations prevent 722,000 deaths over a lifetime, so the parents whom are abdicating these preventive measures must be assuming some other child or relative will be in that statistic and not their own. Truly it is just a question of time before the actions of one parent bring irreparable illness to the lives of others, which is similar to driving a vehicle without auto insurance. Considering that many of those eschewing immunizations are patrons of  the well heeled in private schools, this population is an easy target for social responsibility through the courts.
And this is the healthpolicymaven signing off, encouraging all to share this article virally, just as childhood diseases are spreading through our population.
Roberta Winter is the author of
Roberta E. Winter is a graduate of the University of Washington School of Public Health and Community Medicine and the Evans School of Public Affairs. She has spent the past 12 years advocating for consumer issues in health care.


Monday, February 2, 2015

Insurance Mandate Tax Tips and Report Card on Performance

One Year Out From the Inaugural Insurance Exchange Launch
Now that the nation has passed its second enrollment in the Affordable Care Act (ACA) Insurance Exchanges, it is time to do a bit of a scorecard and though the second enrollment went well, let's look as the predictions versus the actual participation.
Original Whitehouse Projections Versus Actual Enrollment

Number expected to gain insurance coverage because of either the employer or individual insurance mandates under the ACA-32,000,000
Since the employer mandate is just starting this year and the phase-in penalty for firms without compliant medical plans only applies to firms with 100 or more eligible employees, it is not possible to discern the total reduction in the uninsured yet. But here is the rate of the uninsured as a proportion of the national population.
Uninsured rate prior to ACA- 18% After ACA-12.9%
Number Health & Human Services projected for the 2015 Insurance Exchange Enrollment-9,100,000

Number of the uninsured who obtained coverage through Medicaid or an Exchange product-9,500,000, which exceeded their projection by 4%. This information  may be found at:

Number enrolled in the federal insurance exchange-7,100,000
Number enrolled in private insurance exchanges-2,400,000

Percentage of  Actual Enrollment compared to the Eligible Enrollees
I reviewed the Kaiser Family Foundation's report on the insurance exchange enrollment by state and it was no surprise there was a lot of variation, with a low enrollment in the states with robust economies, such as North Dakota (13%) and Massachusetts (8%). Whereas, 87% of the population deemed eligible to enroll in the insurance exchange in Vermont actually did. For more information go to the Kaiser Foundation web site at:

Income Tax Tips for Insurance Exchange Participants
For my followers, I have been tweeting tax tips regarding the reconciliation of the government tax credits for those who purchased insurance through the exchanges. To assist those who are filing income taxes, here is a step-by-step guide to the insurance mandate and tax credit posting:
  1. If you purchased medical insurance through an insurance exchange, either federal or state, you may have received an advance from the federal government, to pay for part of your insurance premiums. If you enrolled in Medicaid through an exchange you did not have to pay any premiums and this does not apply to you..
  2. The government advance, which went directly to the insurance company, was an estimate of your tax credit eligibility based on the income and family information you provided at enrollment in the previous year. If your status changed, there may be a difference in the amount the government advanced and what you should have received. 
  3. Your insurance exchange should have distributed form 1095-A by January 31st, assuming they have your current contact information. You will need this form to complete your income tax.
  4. Form 1095-A has a monthly break-down of your insurance premiums for the 2014 year, both the amount you paid, the amount of the tax credits, which is what the government contributed to the cost of the insurance (thank you Uncle Sam), and the total premium.
  5. If you are using an electronic tax preparation tool, which I highly recommend, it will have an insurance page or folder, which will walk you through the form. But just in case you are still old school and use paper returns, the federal tax credits which were used to pay for your insurance will be entered into the Premium Tax Credit form 8962 of your 1040 Personal Income Tax Return. 
  6. Enter your total premiums paid, total premiums credited from the government and wait until you complete your return. After you have entered all of the other information to complete your income tax return you will you have a final result in terms of what your tax credits should have been and what they actually were. If the government estimated too high, then you might owe some money. If the government estimated too low, then you will have a refund coming.
  7. For example-Total insurance premiums were $7,032 for a single individual (yikes) and you paid $348, with the government contributing the rest. The government paid $4,716, but it turns out you were only eligible for $4,368 in credits. This means you owe the difference between the two or roughly $348. This government advance will be deducted from your tax refund or theoretically, you will get a statement saying you owe income taxes.
  8. Bottom line, the federal tax credits were an estimate of what you were eligible for, based on information you provided, and not a guarantee, so expect some variation in the actual result. If the government gave you $4,716 and you only had to give back $600, that is still awesome.
Hopefully this helps some of you with your income tax filing for the 2014 year. This information is not meant to give tax or legal advice (CYA-disclaimer) but is a journalist's view on publicly available information. Feel free to share this with everyone, with appropriate attribution of course.
And this is the healthpolicymaven signing off. Viva Le France!

healthpolicymaven is a trademark which has been in continuous use sine 2007 and is the property of Roberta E. Winter, MHA, MPA, President of Praevalere Inc.