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CHIP Offers Families With Seriously Ill Kids More Financial Protection Than ACA Plans

Kids with chronic conditions are especially vulnerable to health insurance changes, relying as they often do on specialists and medications that may not be covered if they switch plans. A new study finds that these transitions can leave kids and their families financially vulnerable as well.

The research, which examines the spending impact of shifting chronically-ill kids from the Children’s Health Insurance Program (CHIP) to policies offered on the health law’s marketplaces, found that their families’ out-of-pocket costs would likely rise, in some cases dramatically, following a change to marketplace coverage.

The study comes at a time when health insurance issues are on the front burner in Congress. Republican lawmakers are pushing for fundamental changes to the marketplaces and to the Medicaid program. At the same time, Congress must soon decide whether to extend CHIP when its funding ends in September.

Together the state-federal Medicaid and CHIP programs insure nearly 46 million low-income children in the United States. CHIP covers kids whose family income is low but too high to qualify for Medicaid. The eligibility levels  vary by state. Half of states set the upper income eligibility limit at 255 percent of the federal poverty level or higher — about $52,000 for a family of three.

Both programs provide comprehensive coverage for children with little or no out-of-pocket cost to families.

Since passage of the Affordable Care Act in 2010, some policy analysts have advocated moving children who are enrolled in CHIP into marketplace plans and dismantling the CHIP program. But earlier evaluations found, as did this study, that CHIP coverage was better and cheaper than marketplace coverage, said Joan Alker, executive director of the Georgetown Center for Children and Families.

CHIP is much smaller than Medicaid, with more than 8 million children enrolled, roughly 2 million of whom have one of six chronic health conditions, including asthma, attention deficit hyperactivity disorder, diabetes, epilepsy, mood disorders and developmental disorders such as autism, according to the study, which was published in the April issue of Health Affairs.

Using data compiled from state CHIP programs and marketplace plans for 2016 and health care use data from the federal Medical Expenditure Panel Surveys from 2008 to 2013, researchers simulated the annual out-of-pocket costs for children with these six chronic conditions if they were enrolled in CHIP versus one of the plans sold on the marketplaces operated by the federal government.

The spending differences were stark. For every chronic condition and at every income level, cost sharing was higher for children enrolled in marketplace plans than for those in CHIP.

Take the case of asthma, the most common condition that researchers modeled. For a child with asthma whose family income was between 100 and 150 percent of the federal poverty level, or about $20,000 to $30,000 for a family of three, annual out-of-pocket spending on deductibles and copays would be $284 in a marketplace plan, compared with $27 in CHIP — a difference of $257. At higher incomes, the out-of-pocket spending differences were greater. Families with incomes between 251 and 400 percent of the federal poverty level, or about $51,000 to $81,000 for a family of three, would pay $1,227 out-of-pocket annually if they were enrolled in a marketplace plan but just $84 in the CHIP program — a difference of $1,143.

“The lowest income families were relatively well protected by cost-sharing reductions” in marketplace plans, said Amy Davidoff, a senior research scientist in the Department of Health Policy and Management at the Yale School of Public Health, who is one of the study’s co-authors. Those cost-sharing subsidies, which reduce a plan’s deductible, copayments and coinsurance, are available to marketplace customers with incomes up to 250 percent of the federal poverty level — about $51,000 for three people. These subsidies are the subject of a lawsuit, however, and their fate is unclear.

As family income rises, however, the gap between the out-of-pocket costs for the two different types of coverage increases and becomes quite substantial, Davidoff said. “For these families, it would be huge barrier,” she said.

About 97 percent of children on CHIP belong to families with incomes below 250 percent of the poverty level.

The deductible — the amount that people have to pay on their own before insurance covers most services — was a significant factor in the cost differences. The average deductible in marketplace plans for families with incomes between 251 and 400 percent of poverty was $3,126. None of the CHIP programs for families at that income level had deductibles, the study found.

Noting that CHIP has a history of strong bipartisan support, Alker said she is hopeful that it will be extended. “I think it would be very hard for Congress to let CHIP expire,” she said, “and put those children into the marketplace, when according to their leaders it’s about to fold.”

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

HHS, States Move To Help Insurers Defray Costs Of Sickest Patients

As congressional Republicans’ efforts to repeal and replace the Affordable Care Act remain in limbo, the Trump administration and some states are taking steps to help insurers cover the cost of their sickest patients, a move that industry analysts say is critical to keeping premiums affordable for plans sold on the law’s online marketplaces in 2018.

This fix is a well-known insurance industry practice called reinsurance. Claims above a certain amount would be paid by the government, reducing insurers’ financial exposure and allowing them to set lower premiums.

Two states — Alaska and Minnesota — that have seen double-digit increases in ACA plan premiums this year have already moved to implement reinsurance policies, and Oklahoma is making plans to seek federal approval to set up a program. The Idaho legislature also recently passed a health care reinsurance law, and Maine is considering taking similar action.

The Trump administration has told other states they should consider doing the same. On March 13, Health and Human Services Secretary Tom Price sent a letter to all 50 governors soliciting proposals for reinsurance and other options to help cover the costs of consumers with expensive medical conditions.

Long an advocate for more state control of health insurance, Price said the administration is “seeking to empower states with new opportunities that will strengthen their health insurance markets.”

“This is one practical way the administration and states can work together to reduce premiums,” said Matthew Fiedler, a health policy specialist at the Brookings Institution. “While it’s the insurers who get the [support] directly, reductions in insurers’ claims costs ultimately translate into lower premiums for consumers.”

The focus on reinsurance comes as insurers must tell state and federal regulators no later than June 21 whether they will participate in the ACA’s marketplaces in 2018, and what plans they will offer at what price. This issue is separate from other highly publicized efforts underway to preserve federal payments to insurers to cover the costs of deductibles and copayments for low-income enrollees.

The federal law offered the security of a reinsurance program to insurers during its first three years. It helped reduce premiums among insurers by 10 percent in 2014, the last year the impact was analyzed, according to the Congressional Budget Office.

But the ACA reinsurance program ended this year. That helped drive premiums up by an average 22 percent across the country, raising concerns about the stability of the state-based marketplaces — also called exchanges — that provide insurance for people who don’t get it through work or public programs such as Medicare or Medicaid.

Now officials from both political parties are eyeing another part of the health law to help reprise and finance reinsurance programs.

In his letter, Price encouraged states to consider a special provision — known as a Section 1332 waiver — that went into effect this year and opens an avenue for them to pursue exemptions from ACA rules as long as the state plan maintains equivalent or better coverage levels for residents and doesn’t raise federal spending.

The Trump administration is betting that some states can set up reinsurance programs with federal funding. Federal spending on the program would be kept in check because the move will reduce government spending on tax credits that the law gives some low-income exchange customers to help defray the cost of premiums.

Need To ‘Stabilize Things Fast’ 

Consider deep-red Oklahoma. State officials have always held the ACA at arm’s length, leaving the insurance marketplace’s management and details to federal officials. But after rate increases averaging 76 percent this year — second only to Arizona — state officials set up a task force to explore how to put a brake on insurance premiums. The group last month published a multifaceted, 60-page plan for a waiver request. State officials say they will submit the plan to HHS later this year. Among the proposed first steps: reinsurance.

“We are in critical condition,” said Buffy Heater, chief strategy officer at the Oklahoma Health Care Authority. “Reinsurance is a way to stabilize things fast and attract additional insurers and more enrollees.”

Enrollment in the Oklahoma marketplace plan grew just 1 percent in 2017, to 146,300, after fairly robust growth in 2014 and 2015. Still, only about 30 percent of eligible Oklahomans are enrolled, and the number of uninsured in the state grew by 20,000 people in 2017.

Blue Cross Blue Shield of Oklahoma, the only carrier now selling on the state’s insurance marketplace, concurs with Heater’s assessment. The company declined through a spokesman to address state officials’ concern that the insurer was poised to exit the market in 2018. But Kurt Kossen, senior vice president at the Illinois-based Health Care Service Corp., which owns the Oklahoma Blues plan, said in a statement: “We agree reinsurance and well-designed high-risk pools help lower premiums and encourage greater competition.”

The two main health insurance lobbying groups in Washington — America’s Health Insurance Plans and the Blue Cross Blue Shield Association — also support efforts to offer reinsurance.

“We are very much in favor of using reinsurance to help insurers pay for the most expensive claims and to stabilize the marketplaces,” said Kristine Grow, senior vice president for communications at America’s Health Insurance Plans.  

Alaska And Minnesota Spurred To Act

Building on its state-funded reinsurance program for 2017, Alaska has asked the federal government to set aside $51.6 million for a reinsurance pool there for 2018. Lori Wing-Heier, director of the state’s division of insurance, said the state’s $55 million fund this year enabled Premera Blue Cross Blue Shield, the sole insurer left on the exchange, to reduce an expected premium increase of 40 percent to just 7.3 percent.  But the state said it cannot keep up the effort alone and needs federal funding.

In Minnesota, where premiums for marketplace plans spiked by around 50 percent this year, the Legislature enacted a law this month that establishes a $271 million reinsurance pool for that state’s troubled ACA marketplace for 2018 and 2019. The funds are contingent on getting the same waiver from the federal government that Alaska seeks and that Oklahoma plans to pursue.

Consumer complaints about the price hikes for 2017 pushed Minnesota to set up a $326 million fund to bail out insurers and help consumers who didn’t qualify for federal premium subsidies. That state-based reinsurance fund reduced premiums by about 25 percent, said Eileen Smith, a spokeswoman for the Minnesota Council of Health Plans. The state’s Department of Commerce has estimated that the 2018 reinsurance fund will reduce premiums by about 20 percent.

About 4 percent of Minnesotans — 235,000 people — get coverage in that state’s individual marketplace.

Back in Washington, D.C., some lawmakers have newfound fervor for insurance market stability and tools such as reinsurance. In their proposed bill to repeal and replace portions of the ACA, House Republicans included a 10-year, $100 billion fund to offset the burden of high-cost patients.

States would be allowed to establish reinsurance pools or set up separate high-risk insurance pools for patients with expensive medical conditions.

And even as the fate of the legislation to repeal the ACA remains uncertain, a group of Republicans in the House of Representatives this month sought to sweeten the pot with an additional $15 billion fund over nine years to help reimburse insurers for high-cost patients with certain preexisting conditions, such as cancer.

Democrats and health policy analysts immediately criticized this latest proposal.

“It’s not enough money to make a serious dent,” said Tim Jost, a professor of health law at Virginia’s Washington and Lee University and an expert on the health law. While the concept is sound, he said that the proposal is flawed because the House Republicans’ bill creates the need for it with “the other damaging changes it makes to the market.”

Jost, other policy analysts and consumer advocates also take issue with Republican proposals that appear to create equivalency between reinsurance and separate high-risk pools for people with preexisting conditions and high claims. In most states that have tried them, said Lynn Quincy, a health insurance specialist and senior policy analyst at Consumer Union, high-risk pools have failed to offer affordable coverage to people who need care the most.

“Reinsurance is the much preferred option,” Quincy said. “It doesn’t segregate sick people into a separate pool, and reinsurance has proved far more efficient and effective over the years.”

How to Meet Your Protein Needs without Meat

Eating a vegetarian diet can be very healthful and rewarding. However, most vegetarians—including soon-to-be vegetarians and their meat-eating loved ones—are concerned about getting adequate protein. Most people are accustomed to getting protein from meat, but what else contains protein? Aren't plant-based proteins "incomplete" or lower quality? Fortunately, with a bit of extra attention, you won't have any trouble meeting your protein needs just because you give up meat. There are so many protein-packed vegetarian options! Did you know that most foods, including vegetables, have some of the essential muscle-building nutrient? Without looking closely, it is easy to miss some great sources. (Who knew a cup of broccoli had 3 grams!) Nuts, seeds, soy products, cereal, eggs and dairy are all good meatless protein choices. These groups of food each contain different amino acids (the building blocks of proteins) and different levels of protein quality. There is no need to consume certain foods in special combinations as nutritionists once thought! When your diet includes a variety of each of these types of foods, you can rest assured that you're consuming all the amino acids you need for muscle growth and cell repair.  Pin this graphic for easy reference and scroll down for more details. Nuts Nuts provide a good dose of protein along with some heart-healthy fatty acids and antioxidants (vitamins A and E). They are also packed full of fiber. Take your pick! Many nuts have a significant source of protein ready to work for your body. Peanuts, almonds, pistachios, cashews, and pine nuts are among the highest in protein, while chestnuts and hazelnuts, although they do still have some protein, are the lowest. Think out of the box when you’re adding nuts to your diet. They can be grated, toasted, ground or eaten raw and are great when combined with salads, wraps, soups and stews and baked goods. But pay special attention to portion size! Nuts are a great source of many nutrients, but do come with a hefty dose of calories, thanks to the healthy fats they contain. A single serving is just 1 oz! Many nuts are best when stored in a refrigerator, which helps keep their fats from going rancid (for up to 6 months).   Nuts, 1/4 cup Protein Calories Fat Peanuts, raw 9 g 207 18 g Almonds, dry roasted 8 g 206 18 g Pistachios 6 g 171 14 g Hazelnuts 5 g 212 21 g Pine nuts 5 g 229 23 g Cashews, raw 5 g 197 16 g Walnuts 4 g 164 16 g Seeds Seeds are another great way to grab a few grams of protein and many other nutrients. Healthful unsaturated fats, as well as phytochemicals, make seeds a powerhouse for heart disease and cancer prevention. Just a quarter cup of pumpkin seeds (also called pepitas) has 8.5 grams of protein. Add this amount to a salad or eat them plain for a quick snack. Sunflower seeds are easy to add to pasta or salads, or sandwich wraps, while sesame seeds are easily ground and sprinkled onto steamed veggies for a protein dusting.   Seeds (1/4 cup) Protein Calories Fat Hemp seeds 15 g 232 18 g Pumpkin seeds, roasted 9 g 187 16 g Flaxseed 8 g 191 13 g Sunflower seeds, roasted 8 g 205 18 g Sesame seeds, roasted 6 g 206 18 g Legumes Dried peas, beans and lentils belong to a group of food known as "pulses" or "legumes." Aside from soybeans, these plants have a very similar nutrient content, which includes a good dose of protein. On average, they have about 15 grams of protein per cup, and tagging along with the essentials protein are fiber and iron. Adding beans, lentils and dried peas to your meals is a great way to replace meat (a beef burrito can easily become a black bean burrito, for example) while still getting your much needed protein. Add pulses to soups, salads, omelets, burritos, casseroles, pasta dishes, and more! Make bean dips (such as hummus, which is made from garbanzo beans, or black bean dip) to spread on sandwiches and use as protein-packed dips for veggies or snack foods.   Legumes, 1 cup cooked Protein Calories Fiber Soybeans 29 g 298 10 g Lentils 18 g 230 16 g Split peas 16 g 231 16 g Navy beans 16 g 258 12 g Garbanzo beans (chickpeas) 15 g 269 12 g Black beans 15 g 227 15 g Kidney beans 15 g 225 11 g Lima beans 15 g 216 13 g Pinto beans 14 g 234 15 g Soy Soybeans are a complete protein that is comparable in quality with animal proteins. Eating soybeans (and foods made from soybeans) has been growing trend in America for only five decades, but this protein-rich bean has been a staple in Asia for nearly 4,000 years! This plant powerhouse is used to create a variety of soy-based foods that are rich in protein: tofu, tempeh, textured vegetable protein (TVP, a convincing replacement for ground meat in recipes), soymilk and "meat analogs," such as vegetarian "chicken" or faux "ribs" are all becoming more popular as more Americans practice vegetarianism. To learn more about using tofu, read Tofu 101. To learn how soy may impact your health, click here.   Soy Foods Protein Calories Fat Soybeans, 1 cup cooked 29 g 298 10 g Tempeh, 4 oz cooked 21 g 223 13 g Edamame, 1 cup shelled 20 g 240 10 g TVP, 1/4 cup dry 12 g 80 0 g Soy nuts, 1/4 cup roasted 11 g 200 1 g Tofu, 4 oz raw 9 g 86 5 g Soy nut butter, 2 tablespoons 7 g 170 11 g Soymilk, 1 cup sweetened 7 g 100 0.5 g Soymilk, 1 cup unsweetened 7 g 80 0.5 g Grains In a culture that focuses largely on wheat, it's easy to overlook the many types of other grains available to us. Some of these grains are very high in protein and can be included in your diet for both whole-grain carbohydrates and muscle-building protein. Quinoa is unusually close to animal products in protein quality, making it an excellent grain to replace white rice or couscous. It can also be cooked and mixed with honey, berries and almonds in the morning for a protein-packed breakfast. Other grains high in protein include spelt, amaranth, oats and buckwheat. Choose whole-grain varieties of cereals, pastas, breads and rice for a more nutritious meal.   Grains Protein Calories Fiber Amaranth, 1 cup cooked 9 g 238 9 g Quinoa, 1 cup cooked 9 g 254 4 g Whole wheat pasta, 1 cup cooked 8 g 174 6 g Barley, 1 cup cooked 7 g 270 14 g Spelt, 4 oz cooked 6 g 144 4 g Oats, 1 cup cooked 6 g 147 4 g Bulgur, 1 cup cooked 6 g 151 8 g Buckwheat, 1 cup cooked 6 g 155 5 g Brown rice, 1 cup cooked 5 g 216 4 g Whole wheat bread, 1 slice 4 g 128 3 g Sprouted grain bread, 1 slice 4 g 80 3 g Dairy If you consume milk products, dairy is a great way to add some extra grams of protein to your day. Low-fat milk, cheese and yogurt are easily accessible, quick to pack and fun to incorporate into many meals and snacks. Whether you’re drinking a cup of skim milk with your dinner or grabbing some string cheese before you run errands, you can pack about 8 grams of protein into most servings of dairy. You’re also getting some bone-building calcium while you’re at it! Keep in mind that low-fat varieties of milk products are lower in calories and fat, but equal in calcium to the full-fat versions; low-fat varieties may also be higher in protein.   Dairy Protein Calories Fat Fat-free cottage cheese, 1 cup 31 g 160 1 g 2% cottage cheese, 1 cup 30 g 203 4 g 1% cottage cheese, 1 cup 28 g 163 2 g Fat-free plain yogurt, 1 cup 14 g 137 0 g Low-fat plain yogurt, 1 cup 13 g 155 4 g Parmesan cheese, 1 oz grated 12 g 129 9 g Whole milk yogurt, 1 cup 9 g 150 8 g Goat's milk, 1 cup 9 g 168 10 g 1% milk, 1 cup 8 g 102 2 g Swiss cheese, 1 oz 8 g 106 8 g 2% milk, 1 cup 8 g 121 7 g 3.25% (whole) milk, 1 cup 8 g 146 8 g Low-fat cheddar/Colby cheese, 1 oz 7 g 49 2 g Part-skim mozzarella cheese, 1 oz 7 g 72 5 g Provolone cheese, 1 oz 7 g 100 8 g Cheddar cheese, 1 oz 7 g 114 9 g Blue cheese, 1 oz 6 g 100 8 g American cheese, 1 oz 6 g 106 9 g Goat cheese, 1 oz 5 g 76 6 g Feta cheese, 1 oz 4 g 75 6 g Part-skim ricotta cheese, 1 oz 3 g 39 2 g Eggs Eggs contain the highest biologic value protein available. What this means is that an egg has a near perfect combination of amino acids within its shell; when assessing protein quality of all other foods (including meat), nutrition experts compare them to the egg. This doesn’t mean that all other sources of protein are less healthful or less important but does mean that an egg is an awesome way to get a few grams of protein. At 6 grams for one large egg, there are endless ways to add it to your diet. Salads, sandwiches, breakfasts or snack—an egg can fit in anytime!   Eggs Protein Calories Fat Egg, 1 boiled 6 g 68 5 g Egg white, 1 cooked 5 g 17 0 g Liquid egg substitute, 1.5 fl oz 5 g 23 0 g As you can see, protein is EVERYWHERE in our diet, and even without meat you can get enough every day; you just have to look in the right places! For more ideas for using these various plant-based proteins, check out our dailySpark series, Meat-Free Fridays for recipe and cooking ideas! Selected Sources Information Sheet: Protein from The Vegetarian Society (VegSoc.org) Various nutrient profiles from The World's Healthiest Foods (WHFoods.com) Want to learn more about going meatless? Check out SparkPeople's first e-book! It's packed with over 120 delicious meat-free recipes, plus tips and tricks for going meatless. Get it on Amazon for $2.99 and start cooking easy, wholesome veg-centric meals the whole family will love!Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=158

Best and Worst Salad Toppings

A few years back I typed up a list of New Year’s resolutions on a small piece of cardstock, laminated it, and put it in my wallet. On that list was the resolution to eat a salad every day, simply because eating salad always made me feel like I was doing something good for myself. After all, salad provides several vitamins and can fill you up while reducing your caloric intake. What could be healthier than a big, fresh salad? Unfortunately, many things, as I later found out. Salads can run the gamut of healthiness, depending on what is in them. Although that big bowl of greens may be packed full of antioxidants and fiber, it can also be laden with fat, cholesterol, and sodium—not to mention an overabundance of calories. Some restaurant salads can even contain more calories than a cheeseburger! Luckily, like most things in life, a salad is the outcome of several small decisions. To make sure you don't sabotage your healthy diet unintentionally, choose wisely the next time you order a salad from a restaurant or visit the salad bar. When dining out, don't be afraid to ask questions, make special requests (extra veggies, dressing on the side, light cheese) and ask about substitutions (like grilled chicken for breaded). Most restaurants will be happy to accommodate you as long as their kitchen is stocked with the ingredients you want. Here’s how to choose wisely next time you're making a salad at home or choosing one from a menu. Lettuce The foundation of most salads, lettuce adds substance, crunch, water, and fiber for very few calories—only about 10 per cup. But if you want all that and vitamins, too, toss out the iceberg and toss in the romaine, mixed baby greens and spinach. While iceberg lettuce is lower in nutrients (and still makes a decent choice if it's the only thing available), these other greens are rich in vitamins A, C and K, manganese, and folate. Protein Adding protein, such as lean meat, tofu, eggs or beans, will help bulk up your salad and keep you full longer. Unfortunately, many protein toppings are deep-fried, breaded and greasy, which adds unnecessary calories plus cholesterol, sodium and fat to your salad. Skimp on fattier toppings such as bacon and fried (breaded) chicken strips, and go for lean proteins instead. Grilled chicken, canned beans of all kinds, chickpeas, tofu, hardboiled eggs (especially whites), or water-packed tuna are leaner choices. Nuts and seeds are popular in salads, too, and while they’re a healthy source of good fats and some protein, they’re not exactly low-cal. If you choose to add them, watch your portions (1/2 ounce contains more than 80 calories). Cheese Restaurants know that people love cheese, so they tend to pile on multiple servings of it on their salads. It might be tasty, but it sends the calorie counts sky high! While cheese is a nutritious food that adds flavor, calcium, and protein to a salad, enjoy it in moderation due to its high fat content. Just a half-cup of cheddar cheese (the amount on many large restaurant salads) contains 18 grams of fat and 225 calories. To keep calories in check, use a single serving of cheese (approximately 2 tablespoons). Choose low-fat varieties as much as possible to save on saturated fat and calories. A smaller amount of a stronger-flavored cheese, such as Brie, feta, chevre, gorgonzola, sharp cheddar or bleu cheese will go a long way in helping you cut down on your portions. Pile on the Veggies Vegetables like bell peppers, grated carrots, sugar snap peas, and tomatoes provide flavor, fiber, and vitamins for few calories. Grated carrots, for example, have only 45 calories in a whole cup, and there are only about 20 calories in an entire red bell pepper. When building your best salad, use as many veggies as possible for extra filling power—and a nice crunch! Practice moderation when it comes to starchy vegetable toppings like corn and potatoes, which are higher in calories. And remember to go for a variety of colors to ensure you're getting several different nutrients and antioxidants in your salad bowl. Don't Forget the Fruit Don't leave fruit on the sidelines! Fresh, canned and dried fruits add a sweetness that can help temper the slightly bitter taste of greens and veggies. They also provide color and texture (not to mention nutrition) to your salad bowl. Chopped apples, pears, grapes, or mandarin oranges (canned in juice—not syrup—and drained) are excellent salad toppers. Chewy dried fruits (cranberries, raisins) work well, too, but they are also high in calories (so only use a sprinkle!). Avocados (and the guacamole made from them) are creamy and nutritious thanks to their heart-healthy fats, but they're also a concentrated sources of calories. Keep your use of avocado to a minimum if you're watching your weight. Crunchy Toppings Sesame sticks, crispy noodles and croutons are salty and crunchy but conceal lot of hidden fat. Better options include water chestnuts, apple slivers, a small serving of nuts, crumbled whole-grain crackers, and homemade croutons. To make your own low-fat croutons, just slice a large clove of garlic and rub it over both sides of a piece of whole-grain bread. Cut the bread into cubes and then brown it in the toaster or conventional oven. Dressing A very healthy salad could go very wrong with one too many shakes of oil or dressing. The main issue with dressing is its fat and sodium content—and the fact that people have trouble controlling their portions. Two tablespoons is an appropriate serving of dressing, but most restaurants serve much more than that, whether mixed in to your salad or served on the side. Those calories add up fast. When dining out, always ask for dressing on the side and dip your fork into the dressing before picking up your bite of salad. Caesar, ranch and other cream-based dressings (when not specified as low-fat) are calorie bombs worth avoiding. Look for dressings specified as "low-fat" that contain no more than 60 calories per serving. You can also add flavor for minimal calories by using salsa, vinegar or lemon juice. Salad may be the symbol of healthy eating, but not every salad is healthful—or diet-friendly. The healthfulness of your next salad depends on the simple choices you make when topping or dressing it. Perhaps my greatest discovery about salads was that because you can customize them so easily, you could make a huge main-course salad for a very small amount of calories. Pile in the lettuce and veggies, add a moderate amount of lean protein, sprinkling some cheese and a little something crunchy and measure a portion-controlled side of dressing, and you’ve got a dinner that won’t leave you feeling hungry.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1388

Umami: What You've Been Missing!

You've slimmed down your recipes, made healthy food swaps, and integrated vegetables into your meals. But do you ever feel like your food is missing something? When you finish eating, do you ever wonder why a meal just didn't hit the spot? You're probably missing umami. You've probably heard of the four basic tastes: bitter, sour, sweet and salty. Well, "umami," which means "yummy" in Japanese, is another distinct taste. Commonly found in fermented or aged foods, umami (pronounced ooh-mah-mee) adds that "mouth feel" to food. It makes your food feel richer, more delicious and more decadent. A key component in Chinese and Japanese cuisine, umami is starting to gain importance in Western cooking. American cooking tends to rely on fat or salt to get that feeling, but there are other, healthier ways to give your food and meals a little more oomph. Ever notice how parmesan makes pasta taste so much better? Or how much tastier ketchup makes your burgers? The parmesan, the tomatoes, and the beef all contain umami. Think about Japanese miso soup or almost any Chinese food. They're delicious and satisfying, thanks to umami-rich seaweed, fish, and soy sauce. Many foods are considered to have umami, including familiar foods like pepperoni pizza and hamburgers! And many condiments that seem to add "empty" calories (ketchup, steak sauce and Worcestershire sauce) actually help food feel more satisfying when you eat it. Here's a list of some umami rich foods:

By adding more of these foods to your meals, you can boost your satisfaction and potentially eat fewer calories overall and avoid overeating. A little goes a long way, and many foods rich in umami should be used as seasonings rather than main ingredients because they can be high in sodium and fat. Try adding a pinch of Romano cheese to steamed veggies or adding asparagus or mushrooms to your salad. If you're feeling decadent, put a pinch of crumbled bacon or a couple of sun-dried tomatoes in an egg white omelet. That could be just what hits the spot! Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1348

30 Ways to Revitalize Your Lunch Break

Lunchtime doesn't have to be bland or boring, just as it doesn't have to be a frenzied time to run errands or multitask. Our printable calendar provides 30 ideas to add a little adventure to your midday break. Click here to download and print your Adventurous Lunch Break Calendar. (You need Adobe Acrobat Reader to download this PDF.) If you think your friends or family members might benefit from these heart-healthy tips, share this calendar with them by clicking the "Share" button below.Article Source: http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1336

25 Ways to Run Faster—Stat

Usain Bolt makes sprinting look easy. It’s almost as if he doesn’t have to try. But we’ll let you in on a little secret: Sure, Bolt is more of a natural runner than we are, but he still has to work at it in order to keep himself in top form. Even better news? There are tons of steps you can take to run faster, smoke the competition, and maybe even sent a new PR. 

1. Nail good form.

The key to running (at any speed) is to practice proper running technique. That means keeping your upper body tall yet relaxed, striking the ground with your mid-foot landing under your hip, and swinging your arms forward and back (not side to side!) at low 90-degree angles.

2. Count your steps.

Get familiar with stride turnover—the rate of steps you take while running, regardless of pace. The fastest, most efficient runners have a cadence of around 180 steps per minute and keep their feet close to the ground with light, short, and speedy steps. To find your magic number, run for one minute, count the number of times the right foot hits the ground, and multiply by two.

3. Try interval training.

Short on gym time? Try interval training. Alternate periods of high and low intensity while exercising to build speed and endurance—and burn major calories in less time too!

4. Don't forget to sprint.

There's a reason you see all those “real runners” doing short sprints before the big road race. Strides are a series of comfortable sprints (usually eight to 12, between 50 and 200 meters each) to improve acceleration technique.

5. Make the treadmill your friend.

The treadmill's belt assists with leg turnover, so it's actually easier to run faster. Plus, you have the power to push the pace right at your fingertips. Just make sure you get on the machine before turning up the dial.

6. Stretch daily.

The jury is still out on static stretches—it's unclear if they really prevent running injuries.  Stretching and injury prevention: an obscure relationship. Witvrouw E, Mahieu N, Danneels L. Sports medicine (Auckland, N.Z.), 2004, Dec.;34(7):0112-1642. But leaders of the pack know stretching daily (especially targeting those hip flexors) increases flexibility for better strides.

7. Switch up your pace.

Fartleks is a funny Swedish word (yes, our inner 10-year-old finds it hilarious) meaning “speed play.” Alternating jogs and sprints gradually builds up speed and endurance, plus you call the shots in determining when to switch it up.

8. Jump rope.

Take a lesson from boxers and add jump rope workouts to your routine. Boxers know that fast feet mean fast hands. But for runners, fast feet just equal fast feet.

9. Trade up for lighter shoes.

We're not saying you need to embrace barefoot running, but sneakers are getting lighter and lighter to mimic your foot's natural movement and improve your stride. Try a minimalist pair to see if less weight means more energy for faster feet.

10. Work out your core. 

Stronger core muscles (especially lower abs) allow runners to tap into more force out on the road. The best part? Just 15 minutes of core work a few days per week is enough to help you speed up. Does core strength training influence running kinetics, lower-extremity stability, and 5000-M performance in runners? Sato K, Mokha M. Journal of strength and conditioning research, 2009, May.;23(1):1533-4287.

11. Change how you breathe.

Learning how to breathe while running at faster speeds takes practice. Use both your nose and mouth while inhaling and exhaling to get the maximum amount of oxygen to the muscles. Also, try belly breathing—fill the stomach, not the chest, with air on each inhale.

12. Head for the hills.

Hill repeats are shown to improve speed, build muscle strength, and add a boost of confidence too.

13. Skip the sweets.

Junk food guarantees a sugar high and slows you down. Stick to whole grains and pasta before runs, which provide long-lasting energy—without the crash.

14. Play with resistance.

Try a running parachute for added resistance, or if your budget allows, see what it's like on the other edge of the resistance spectrum with an anti-gravity treadmill.

15. Lift weight.

Stronger, leaner muscles will help you get to the finish line faster. And while runners shouldn't take up bodybuilding, two short strength training sessions per week can go a long way in improving your speed.

16. Lose weight.

On the other hand, research shows that shedding the pounds (fat, not muscle) can help runners shave time off the clock—cutting an average of two seconds off your mile time for every pound you lose. Of course not everyone has the weight to lose, so remember to consult a physician before starting any weight-loss program.

17. Look ahead.

Looking down at your feet or turning your head to check out the competition can waste precious time. Instead, focus on what's directly in front of you—about 10 to 20 meters in the distance—and keep those eyes on the prize.

18. Go for a spin.

Indoor cycling gives your hips a workout while forcing your legs to get comfortable moving from slow leisurely rides to all-out sprints. The same goes for running. So hop on a bike and get ready for some cross-training.

19. Pay attention to your toes.

The whole body plays a role in speed—from your head to your toes! Try dorsiflexion (arching your toes up toward you shins) while running. That way less of your foot hits the ground for a quicker stride turnover.

20. Keep it steady.

Slow and steady may win the race, but fast and steady builds speed! A tempo run challenges runners to find a “comfortably hard” pace and hold it for a 20-minute period. Just don't burn out before the run is over like that silly little hare!

21. Drink coffee.

Turns out drinking caffeine before running gives you an extra jolt of speed. Even more good news? It's a totally legal performance enhancer.  Caffeine and sports performance. Burke LM. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolisme, 2009, Mar.;33(6):1715-5312.

22. Do mountain climbers.

The combo of moving your feet quickly while assuming a plank position will make you crazy fast. 

23. Try yoga.

Get a leg up on fellow runners by adding yoga to your training plan. The increased flexibility from runner-specific positions makes you faster and speeds up aids recovery.

24. Get enough shut-eye.

Studies show well-rested athletes have better reaction times and clock faster finishes.  The Effects of Sleep Extension on the Athletic Performance of Collegiate Basketball Players. Man C, Man K, et al. Sleep. 2011 Jul 1; 34(7): 943–950.  And think about it—the faster you run, the more time you have to kick back and relax!

25. Strip down.

When it's finally race day, take it off! The extra layers and fuel belts, that is. The less clothing and gear on your body, the faster your time—which is why the pros practically get right down to their skivvies to run.

Originally published January 2012. Updated February 2014 and April 2017.

Luxury retailer Jimmy Choo up for sale 

Luxury retailer Jimmy Choo is on the market.

>> Read more trending news 

The BBC reports the high-end shoe brand is seeking offers, but has not yet received any bids. 

Jimmy Choo believes a sale would “maximize ... value for its shareholders,” a company statement said Monday.

Right now, the British brand has a market value of nearly $900 million and operates more than 150 stores worldwide. 

According to Business Insider, its shares slumped last summer, but have since rebounded, increasing 35 percent over the last year.

JAB Holdings Inc., a long-term investment company, currently holds 68 percent of Jimmy Choo. While it is “supportive of the process,” it also said there is “no certainty that an offer will be made, nor as to the terms on which any offer will be made.”

JAB Holdings, which also holds ownership in Krispy Kreme and Caribou Coffee, purchased Panera Bread earlier this month.

>> Related: Krispy Kreme owner buys Panera Bread for $7 billion

Jimmy Choo was co-founded in 1996 by former “Vogue” editor Tamara Mellon and Choo, who once worked for Princess Diana.

The brand received global attention after its shoes appeared in films “Sex and the City” and “The Devil Wears Prada.”

A single pair of Jimmy Choo shoes can sell for more than $1,000.

Traditional retailers have faced recent tough times. Many iconic brands, from Bebe to Ralph Lauren, are closing stores and taking other drastic measures to stay afloat. Department stores, including Macy’sSears, and J.C. Penney, are shuttering mall locations nationwide. Billionaire investor Warren Buffett blamed the trend in part on the rise in popularity of e-commerce companies, such as Amazon.

>> Related: Wet Seal closing all stores

>> Related: Payless ShoeSource to close 400 stores, files for bankruptcy

3-Ingredient Breakfasts to Throw Together When You Have No Time

Whether you’re running out the door to work or just remembered you agreed to host Sunday brunch, odds are you need a ridiculously quick breakfast recipe. Calling for just three ingredients each, these nine sweet and savory breakfasts come together faster than you can make a stop at the bagel place—better yet, the ingredients are probably stuff you already have in the kitchen.

1. Three-Ingredient Pancakes You don’t have to save your pancake breakfast for the weekend. This pancake batter is just eggs, milk, and flour—we think that’s perfectly reasonable to mix up before work or on a Sunday morning. 2. Three-Ingredient Bacon and Egg Cups Make the cutest personal bacon and eggs for brunch: Crack an egg into each cup of a muffin tin lined with a strip of cooked bacon. Sprinkle with chives, then bake until eggs are cooked. 3. Three-Ingredient Acai Bowl This vibrant acai bowl looks intricate, but it’s actually ridiculously easy to make. Blend a frozen acai pack, a frozen banana, and a bit of nondairy milk or yogurt into a thick purple smoothie. Top with fruit and granola, or spoon it up as is. 4. Three-Ingredient Eggs and Sweet Potato Skillet Essentially a giant cheesy, eggy hash brown, this speedy vegetarian breakfast skillet is a morning dream, thanks to eggs, sweet potatoes, and a bit of sharp cheese. 5. Three-Ingredient Flourless Chocolate Muffins You don’t need to stop for a muffin to grab a quick breakfast. Mix nut butter, cocoa powder, and eggs, then pour into muffin tins. Stash a few in your purse for a hangry emergency. 6. Three-Ingredient Avocado Smoothie This creamy smoothie is packed with good-for-you fats, making it a perfect post-workout meal. Blend avocado, frozen banana, and milk until pale and smooth. Throw it in a jar and drink it on the go if you want. 7. Three-Ingredient Raspberry Chia Seed Pudding Stir chia seeds with a blended mixture of coconut milk and raspberries. Let it sit overnight, then wake up to the easiest (and prettiest) chia pudding breakfast around. 8. Three-Ingredient Breakfast Skillet A breakfast skillet is without a doubt the best meal to serve to a group of friends for brunch, made better only by a short ingredient list. Brown ground turkey in a pan, then add spicy salsa and crack in a bunch of eggs. Breakfast is served. 9. Three-Ingredient Strawberry Overnight Oats Blend frozen strawberries and milk into a thick mixture, then pour into a jar of oats. Stash in a jar overnight, then spoon up all that pink goodness tomorrow morning.

 

Health Care In America: An Employment Bonanza And A Runaway-Cost Crisis

In many ways, the health care industry has been a great friend to the U.S. economy. Its plentiful jobs helped lift the country out of the Great Recession and, partly due to the Affordable Care Act, it now employs 1 in 9 Americans — up from 1 in 12 in 2000.

As President Donald Trump seeks to fulfill his campaign pledge to create millions more jobs, the industry would seem a promising place to turn. But the business mogul also campaigned to repeal Obamacare and lower health care costs — a potentially serious job killer. It’s a dilemma: One promise could run headlong into the other.

“The goal of increasing jobs in health care is incompatible with the goal of keeping health care affordable,” said Harvard University economist Katherine Baicker, who sees advantages in trimming the industry’s growth. “There’s a lot of evidence we can get more bang for our buck in health care. We should be aiming for a health care system that operates more efficiently and effectively. That might mean better outcomes for patients and fewer jobs.”

But the country has grown increasingly dependent on the health sector to power the economy — and it will be a tough habit to break. Thirty-five percent of the nation’s job growth has come from health care since the recession hit in late 2007, the single-biggest sector for job creation.

Hiring rose even more as coverage expanded in 2014 under the health law and new federal dollars flowed in. It gave hospitals, universities and companies even more reason to invest in new facilities and staff.  Training programs sprang up to fill the growing job pool. Cities welcomed the development — and the revenue. Simply put, rising health spending has been good for some economically distressed parts of the country, many of which voted for Trump last year.

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In Morgantown, W.Va., the West Virginia University health system just opened a 10-story medical tower and hired 2,000 employees last year. In Danville, Pa., the Geisinger Health System has added more than 2,200 workers since July and is trying to fill 2,000 more jobs across its 12 hospital campuses and a health plan. Out West, the University of the UCHealth system in Colorado expanded its Fort Collins hospital and is building three hospitals in the state.

In cities such as Pittsburgh, Cleveland and St. Louis, health care has replaced dying industries like coal and heavy manufacturing as a primary source of new jobs. “The industry accounts for a lot of good middle-class jobs and, in many communities, it’s the single-largest employer,” said Sam Glick, a partner at the Oliver Wyman consulting firm in San Francisco. “One of the hardest decisions for the new Trump administration is how far do they push on health care costs at the expense of jobs in health care.”

House Republicans, with backing from Trump, took the first swipe. Their American Health Care Act sought to roll back the current health law’s Medicaid expansion and cut federal subsidies for private health insurance. The GOP plan faltered in the House, but Republican lawmakers and the Trump administration are still trying to craft a replacement for Obamacare.

Neither the ACA nor the latest Republican attempt at an overhaul tackle what some industry experts and economists see as a serious underlying reason for high health care costs: a system bloated by redundancy, inefficiency and a growing number of jobs far removed from patient care.

Labor accounts for more than half of the $3.4 trillion spent on U.S. health care, and medical professionals from health aides to nurse practitioners are in high demand. But the sheer complexity of the system also has spawned jobs for legions of data-entry clerks, revenue-cycle analysts and medical billing coders who must decipher arcane rules to mine money from human ills.

For every physician, there are 16 other workers in U.S. health care. And half of those 16 are in administrative and other nonclinical roles, said Bob Kocher, a former Obama administration official who worked on the Affordable Care Act. He’s now a partner at the venture capital firm Venrock in Palo Alto, Calif.

“I find super-expensive drugs annoying and hospital market power is a big problem,” Kocher said. “But what’s driving our health insurance premiums is that we are paying the wages of a whole bunch of people who aren’t involved in the delivery of care. Hospitals keep raising their rates to pay for all of this labor.”

Take medical coders. Membership in the American Academy of Professional Coders has swelled to more than 165,000, up 10,000 in the past year alone. The average salary has risen to nearly $50,000, offering a path to the American Dream.

“The coding profession is a great opportunity for individuals seeking their first job, and it’s attractive to a lot of medical professionals burned out on patient care,” said Raemarie Jimenez, a vice president at the medical coding group. “There is a lot of opportunity once you’ve got a foot in the door.”

Some of these back-office workers wage battle every day in clinics and hospitals against an army of claims administrators filling up cubicles inside insurance companies. Overseeing it all are hundreds of corporate vice presidents drawing six-figure salaries.

Administrative costs in U.S. health care are the highest in the developed world, according to a January report from the Organization for Economic Cooperation and Development. More than 8 percent of U.S. health spending is tied up in administration while the average globally is 3 percent. America spent $631 for every man, woman and child on health insurance administration for 2012 compared with $54 in Japan.

America’s huge investment in health care and related jobs hasn’t always led to better results for patients, data show. But it has provided good-paying jobs, which is why the talk of deep cuts in federal health spending has many people concerned.

Linda Gonzalez, a 31-year-old mother of two, was among the thousands of enrollment counselors hired to help sign up Americans for health insurance as Obamacare rolled out in 2014. The college graduate makes more than $40,000 a year working at an AltaMed enrollment center, tucked between a Verizon Wireless store and a nail salon on a busy street in Los Angeles.

In her cramped cubicle, families pull up chairs and sort through pay stubs and tax returns, often relying on her to sort out enrollment glitches with Medicaid. As the sole breadwinner for her two children, ages 9 and 10, she counts on this job but isn’t sure how long it will last.

“A lot of people depend on this,” she said one recent weekday. “It’s something I do worry about.”

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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