Author Archives: Martha Bebinger

Martha Bebinger covers health care and other general assignments for WBUR. She was a Nieman Fellow at Harvard University, class of 2010.

What The Supreme Court Ruling On Obamacare Means: A Student’s Perspective

By Marina Renton
CommonHealth Intern

As a public health major at Brown University, I’ll admit I’m biased: When the King v. Burwell decision was handed down this week, I was absolutely elated. The decision felt exactly right to me; people were not going to lose their health care coverage, and more might even have the chance to gain it.

But the case is complicated, so to really understand the take-home messages, I consulted a couple of health care policy experts.

One is Ira Wilson, professor of Health Services, Policy and Practice at Brown University, who taught my “Health Care in the United States” class last semester.

The other is Michael Doonan, assistant professor at the Heller School for Social Policy and Management at Brandeis and executive director of the Massachusetts Health Policy Forum

Their responses are lightly edited:

MR: What background do we need to understand the Supreme Court decision?

IW: One of the core tenets of health care reform is that people who can’t afford insurance get subsidies so that they can buy it.

The ACA:

• Reforms insurance by doing things like preventing denials due to pre-existing conditions. So it requires that insurance do certain things that it hasn’t always done in the past.

• Requires that everybody get insurance. That’s the individual mandate, and that was covered in the 2012 challenge and then upheld in the 2012 case.

• Requires that affordable insurance be available to everyone. And this King case threw into question that third leg of the stool, as it were. Or at least it brought it into question for the states that, rather than deciding to develop their own exchange, used a federal one. So without this, the entire framework for health care reform in those states that have a federal exchange begins to fall apart. And as we know because we’ve seen lots of articles about estimating how many people would lose insurance if those subsidies were taken away (estimates were in the six million range), it would have a devastating impact on people who are now insured who would lose it.

What does the ruling say about Obamacare?

MD: If the Supreme Court had ruled against the government and said that the subsidies could not be available in the 34 states that have federally run exchanges, it might not have been the death of Obamacare, but it certainly would have put it on life support. So this decision is really critical in helping root and solidify the Affordable Care Act. And the more it gets rooted in each of the states, the harder it’s going to be to repeal.

IW: So this actually was a 6-3 decision, not a 5-4 decision. And it does seem to me the fact that both Justice Roberts and Justice Kennedy — who were the two that one might have imagined might have been on the other side of this issue — came down on the side of upholding these subsidies is a bit of a statement.

What if the ruling had gone the other way?

MD: Think about Texas. Now, in Texas, there are about 1.1 million people who are enrolled in that exchange, that marketplace. Well, 90% of them — over 900,000 people — are receiving those subsidies, and they could have lost their insurance.

And it’s not only important that people lose their insurance, which is the most critical thing, but hospitals would see many, many more uninsured patients. So even people adamantly opposed — I think that even Republican governors who are opposed to this are secretly saying, “Oh my gosh; thank goodness.” This would have caused them a tremendous, tremendous burden, because they would have seen more uninsured.

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Those Who Worked On Mass. Law Cheer As Supreme Court Upholds Obamacare Subsidies

Jessica Ellis, right, with "yay 4 ACA" sign, and other supporters of the Affordable Care Act, react with cheers as the opinion for health care is reported outside of the Supreme Court Thursday. The court upheld the nationwide tax subsidies under President Obama's health care overhaul. (Jacquelyn Martin/AP)

Supporters of the Affordable Care Act react with cheers as the opinion for health care is reported outside of the Supreme Court Thursday. The court upheld the nationwide tax subsidies under President Obama’s health care overhaul. (Jacquelyn Martin/AP)

Obamacare supporters everywhere are celebrating a win from the U.S. Supreme Court. With a 6-3 vote, the court decided Thursday that Americans who buy coverage through health care exchanges run by the federal government can continue to receive subsidies.

None of the 119,962 Massachusetts residents who have health insurance that is subsidized by the government were at risk for losing coverage based on the ruling. That’s because the commonwealth has a state-run health insurance shopping website, the Massachusetts Health Connector. The case before the high court only dealt with people who buy insurance through the federal health insurance exchange.

But many in Massachusetts had a close personal or professional interest in this case.

“I am very relieved that affordable care can continue nationwide. It’s made a huge difference in Massachusetts,” said Faith Perry, who joined the Greater Boston Interfaith Organization through the Church of the Covenant in Boston.

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Related:

Are Skinny Jeans Bad For Your Health?

(James Mitch/Flickr)

(James Mitch/Flickr)

This is the kind of headline that can trigger a snarky response even in the most compassionate person: “Squatting in ‘skinny jeans’ can damage nerve and muscle fibres in legs and feet.”

Yes, it’s true: A case report published this week in the British Journal of Neurology, Neurosurgery and Psychiatry describes a 35-year-old woman who suffered serious muscle damage, swelling and nerve blockage after squatting in her super tight skinny jeans. (The jeans were so tight, in fact, that doctors had to cut them off to treat her.)

Here’s the top of the report (my bold added):

A 35-year-old woman presented with severe weakness of both ankles.

On the day prior to presentation, she had been helping a family member move house. This involved many hours of squatting while emptying cupboards. She had been wearing ‘skinny jeans’, and recalled that her jeans had felt increasingly tight and uncomfortable during the day. Later that evening, while walking home, she noticed bilateral foot drop and foot numbness, which caused her to trip and fall. She spent several hours lying on the ground before she was found.

On examination, her lower legs were markedly oedematous bilaterally, worse on the right side, and her jeans could only be removed by cutting them off. There was bilateral, severe global weakness of ankle and toe movements, somewhat more marked on the right… Sensation was impaired over the lateral aspects of both lower legs, and the dorsum and sole of both feet…Nerve conduction studies showed conduction block in both common peroneal nerves between the popliteal fossa and fibular head…

The story of the skinny jean medical emergency went viral, with fashionistas and feminists weighing in on whether the era of super-tight jeans is over. The New York Times did a piece headlined “Why You Shouldn’t Throw Out Your Skinny Jeans,” and interviewed the paper’s fashion director, who declared:

Not all skinny jeans are created equal, and it would be alarmism to jump to the conclusion that one pair of skinny jeans created health issues, ergo all skinny jeans are bad. I think the takeaway is skinny jeans are one thing, jeans that actually inhibit movement something else. Maybe we should call them straitjacket jeans. Those should be avoided.

Still, after reading the study, it’s hard not to feel a little empathy. Who among us hasn’t worn a heel just a bit too uncomfortably high, or a pair of movement-limiting pants (and don’t even get me started about thong underwear) in an attempt to feel better/younger/sexier? Continue reading

Medical Marijuana Is Now For Sale In Mass.

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

There’s another milestone in the storied history of Salem. On Wednesday, the state’s first dispensary for medical marijuana opened on the ground floor of a former factory here, a few blocks off a busy thoroughfare. Continue reading

Earlier:

An Uptick In Non-Jews Choosing Jewish Circumcision? Maybe

Reporter Jessica Alpert may have stumbled on a trend: non-Jews choosing to have their infant sons circumcised by traditional mohels, Jews trained to perform the ritual procedure, rather than doctors.

Alpert, a frequent CommonHealth contributor, writes in the current issue of Atlantic:

Finch isn’t the only non-Jew who has felt a connection to the religious elements of the procedure. Nationwide, circumcisions have decreased over the last few decades—from 64.5 percent of newborn boys in 1979 to 58.3 percent in 2010, according to Centers for Disease Control data—but among those opting to circumcise their sons, some non-Jews are forgoing the hospital or doctor’s office and requesting Jewish mohels for reasons both practical and religious. (Reliable statistics on religious circumcisions are hard to come by, but several mohels I talked to said they’ve noticed an uptick in their popularity in recent years.)

Whether or not the practice is taking off, Alpert suggests that this co-mingling of religious and non-religious realms may have “tricky implications for mohels performing non-Jewish circumcisions,” and raise thorny legal questions:

The right to perform brit milah is protected under the First Amendment, but when it’s no longer a religious ritual, mohels may run up against laws that forbid the practice of medicine without a license, explains Marci Hamilton, a church-state scholar and professor at the Cardozo School of Law at Yeshiva University. There is no legal gray area for mohels who are also health professionals—these mohels can perform the procedure on non-Jews as part of their medical practice, even if the primary purpose is religious rather than medical. But others, Hamilton says, may be subject to prosecution when they perform the procedure outside of its religious context.

When it’s a non-Jewish family using a mohel, “The mohel is not acting as a religious participant, and therefore his acts are not protected as free exercise,” she explains. Continue reading

‘Dietland': A Fat Heroine, And The Politics Of Weight

By Jean Fain

The heroine is the news in “Dietland,” the new novel by Sarai Walker. That’s because she’s got the rarest of qualities in a female protagonist: She’s fat.

Also, she has next to no sense of self, and expects to remain selfless until she can afford weight-loss surgery and find her true self as a thin person. In the meantime, Plum Kettle, our heroine, works as a ghostwriter for the slender, glamorous and self-absorbed editor of a teen magazine called Daisy Chain. In short, Plum’s got no life of her own.

Plum’s transformation from fat girl to full-bodied rebel with a cause is the narrative arc of Walker’s provocative and insightful book. Like “Alice in Wonderland,” Plum’s sense of self gets turned on its head by a cast of oddball characters, from the daughter of a famous diet guru and her feminist cohort to a murderous terrorist cell of women avenging crimes against women. When the daughter of the diet guru offers Plum $20,000 to postpone her surgery and confront the real costs of beauty, the plot and subplot blend and thicken.

dietlandDespite the rave reviews from my inner circle and the world at large, I didn’t expect to be drawn in by the writing. But, truth be told, it’s fresh, playful and sometimes hilarious: The parody of the diet industry is spot on. I also didn’t expect to be touched by the rejection and humiliation the 300+ pound Plum encounters along the way to finding herself.

Most unexpected of all: I kind of looked forward to spending my evenings with a fictional someone desperately seeking weight loss. Generally, if I’m desperate for anything at the end of the day with clients (I’m a therapist specializing in eating disorders and food issues), it’s non-diet-related downtime.

I can’t say I always loved reading “Dietland.” Violence, even when served as Walker serves it — with sarcasm and panache — isn’t my cup of tea. I also had trouble swallowing the meanness of the male characters, and the complete self-acceptance of the female ones. And yet, my curiosity kept me turning all 307 pages. I wanted to know if Plum would live more happily ever after. Plus, I wanted to discuss the book with members of my mindful eating support group. (“Dietland” is the group’s first unofficial book club selection.)

At the same time, I kept reading between the lines to learn the author’s story. From the book-jacket flap, I knew Walker writes from professional experience. Before she did her doctoral research on the feminist issue that is fat, she wrote about body image for “Our Bodies, Ourselves,” the feminist classic by the Boston Women’s Health Collective.

From the author photo, I also knew Walker is a fat woman. And yet, combing through the reviews and interviews, I could find very little about Walker’s personal experience with food and body image issues.

The therapist in me really wanted to know if Walker, like Plum, had tried and failed to lose weight over and again? If she’d been a victim of fat shaming and stigma? If she’d been discriminated against because of her appearance? What was Walker’s story?

My curiosity moved me to set up a Skype interview with the NYC-based author. What follows are questions and answers from that recent interview with Sarai (pronounced SUH-ray) Walker.

JF: You seem to know a lot about food and body image issues even though you’re not a medical person or scientist. What can you tell me about your personal experience in this arena?

SW: Well, I’m a fat woman, and so I think one of the reasons I wanted to write “Dietland” is I wanted to explore what it’s like to be a fat woman in our contemporary society because I think, while there are some novels with fat heroines, I feel like there aren’t any novels that explore the issue in a serious way. Continue reading

Baker Announces Plan To Combat Opioid Addiction Epidemic

Gov. Charlie Baker announces recommendations of his Opioid Working Group along with Attorney General Maura Healey, second from left, and Health and Human Services Secretary Marylou Sudders, left, at the State House. (Jesse Costa/WBUR)

Gov. Charlie Baker announces recommendations of his Opioid Working Group along with Attorney General Maura Healey, second from left, and Health and Human Services Secretary Marylou Sudders, left, at the State House. (Jesse Costa/WBUR)

One person living in Plymouth County will die today from an overdose of heroin or another opiate. Gov. Charlie Baker says that sobering average, from just one county, offers a glimpse into the opioid epidemic that rages through every community in Massachusetts.

To combat this epidemic, Baker released a plan of attack. It includes 65 recommendations, drawn from a task force of experts who heard from 1,100 people this winter and spring, many of whom crowded into public hearings to tell their stories.

“Opioid addiction is a health care issue that knows no boundaries across age, race, class or demographics,” Baker said during a press conference Monday. “From the Berkshires, to Boston, to Cape Cod, too many people have heart-wrenching stories of loved ones or friends who have battled with addiction and in some cases lost their lives. Opioid abuse is stealing the livelihood of our children, our siblings, relatives and friends, one person at a time.”

The recommendations include more education for doctors, young people, those at risk for addiction and their family members about the dangers of pain killers. The state will look to add 100 treatment and recovery beds by this time next year. Pharmacists will be required to add pain prescriptions to a statewide database within 24 hours, much more quickly than the current seven days, which Massachusetts is working to connect to databases in other states.

“This is a complicated issue so there’s not going to be a simple fix,” said Health and Human Services Secretary Marylou Sudders.

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New Normal In Age Of Hookup Apps? Rhode Island Rises In Syphilis, Gonorrhea, HIV

(Rhode Island Department of Health)

(Rhode Island Department of Health)

By Marina Renton
CommonHealth intern

The numbers are striking: Recent double-digit rises around the country in long-familiar sexually transmitted diseases — gonorrhea, HIV, even the old scourge of syphilis.

Perhaps even more striking is what Thomas Bertrand of the Rhode Island Department of Health said recently about the rising numbers on Here & Now: “I would not call it a crisis, I’d call it a new normal right now, and we need to push against it.”

Last month, the Rhode Island Department of Health put out a press release with its data from 2013 to 2014: Reported cases of infectious syphilis increased 79 percent, gonorrhea cases increased 30 percent, and newly diagnosed HIV cases increased 33 percent.

While these figures are dramatic, particularly the increase in syphilis, it’s important to remember that year-to-year changes aren’t always the best data to look at, said Bertrand, who is chief of the office of HIV, STDs, Viral Hepatitis, and Tuberculosis for the state Department of Health. It’s better to examine a period of five to 10 years, he says.

But those numbers don’t look good either: Since 2009, Rhode Island, along with the rest of the country, has seen increases in chlamydia, gonorrhea and syphilis, Bertrand said in a phone interview. “We mirror the national trends in general.”

“The acceleration or the increase may be a little bit steeper in Rhode Island than the rest of the country, but just a little bit,” he added.

Can swiping right lead to STDs?

The Rhode Island Department of Health’s statement mentions the use of hookup apps as a “high-risk behavior” that could be associated with the increase in STDs. However: “We don’t have data to say that the use of social media or the people who use it are more infectious or transmitting disease more than people who don’t,” Bertrand said.

But the apps do add to tracking problems: When people use social media such as Tinder and Grindr to arrange hookups, the encounter can be casual and brief, so people don’t share much information, Bertrand said. So, when someone is diagnosed with an STD, he or she might not be able to provide contact information for his or her sexual partners, making it harder to curb the spread of the disease.

Given the use of social media to arrange sexual encounters, there is opportunity for the health department to move online, Bertrand said. Continue reading

For Salem Dispensary, Mass. Issues One-Time Waiver From Marijuana Safety Tests

Massachusetts’ first medical marijuana dispensary will be allowed to open, but for limited sales, while the state reviews safety standards.

Marijuana grown so far tests for lead higher than allowed in Massachusetts, and the state says labs are not equipped to test for seven of 18 restricted pesticides. But the Baker administration will let Alternative Therapy Group, a proposed dispensary in Salem, open as long as it limits each patient to 4.23 ounces and instructs patients to consume no more than two grams a day.

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

“Patients have waited to access marijuana for medical purposes for far too long,” Gov. Charlie Baker said in a statement. “This waiver will allow industry laboratories a little more time to reach full operation while providing safe amounts of medical marijuana for qualifying patients who need it.” Continue reading

Earlier:

When My Mother Died: A Story Of ‘Incomplete Mourning’

By Sarah Baker

I was 8 years old and the sky was black the day my mother died.

That morning, after a five-year struggle with a brain tumor, she’d passed away at Bethesda Naval Hospital, where she had been admitted a couple of days earlier. I hadn’t seen her since.

Grieving wasn’t an option in our house. We were a “chin up, shoulders back” group led by Dad, a rising star in the Navy. At my mother’s graveside in Arlington National Cemetery, my 10-year-old brother and I stood like little replicas of John F. Kennedy Jr. 12 years earlier when he saluted his father’s coffin. There were no tears, no signs of weakness. Long periods of mourning or sadness were not in our family culture — our grief was put on hold. There were bags to pack, and new ports of call. I was Soldiering On.

The Hardest Thing

According to the advocacy group SLAP’D (Surviving Life After a Parent Dies), 1 in 9 Americans loses a parent before age 20. Of those, nearly half said it was difficult to talk about their grief and only 7 percent said a guidance counselor helped. Six out of 10 adults interviewed, who lost a parent when they were children, said it’s the hardest thing they’ve had to deal with.

Sarah Baker at age 6, two years before her mother died (Courtesy)

Sarah Baker at age 6, two years before her mother died (Courtesy)

For us, the coping mechanism of Soldiering On worked splendidly for years, even decades. I survived all of the moves due to Dad’s deployments, even thrived, people might say. I went to college, graduate school, found great jobs, married a wonderful man, and had two beautiful children. All seemed well, at least on the surface.

But years of anxiety and disassociation gripped me. Recently, though, I felt all that emotional baggage was not sustainable. My external world appeared blissful (and it was!) but my internal world reeled. I had periods of blankness, inability to focus, sleeplessness, feelings of isolation when I was surrounded by loving people; despair, longing for something else, numbness, repeating negative loops in my mind, and sensations of being half dead. These feelings came in waves — days of it followed by lightness and connection. The longest darkness lasted three months — the world drained of its colors and none of my usual “reset,” or coping, tools seemed to work.

Necessary Grief

Importantly, coping is not grieving. “There is a kind of sanity to grief,” says Kay Jamison, a professor of psychiatry at the Johns Hopkins School of Medicine and author of “An Unquiet Mind.” “It provides a path — albeit a broken one — by which those who grieve can find their way. Grief is not a disease; it is a necessity.”

Funerals and other rituals bring people together and defend against loneliness. But if the grief lingers too long, is too severe, or unprocessed, it might begin to resemble depression. It’s a fine line indeed.

I now know I had never fully experienced the pain and sorrow of my grief. Continue reading