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UnitedHealth Lowers Forecast, Blaming Affordable Care Act

Medicare -- New York Times - Fri, 11/20/2015 - 12:00am
Citing weak growth in the numbers of new people signing up for coverage, the company said it was reducing its earnings estimates for 2015 and 2016.
Categories: Elder, Medicare

Study: Risk Of Hidden Cancer In Gynecologic Surgery Higher Than Previously Thought

CommonHealth (WBUR) - Thu, 11/19/2015 - 8:54pm

Undetected cancer among women undergoing a type of minimally invasive hysterectomy or fibroid removal surgery is more common than previously thought, a new study finds. Researchers at Boston Medical Center report that the risk of such hidden cancer is about 1 in 352 women.

The upshot: these women may have had the undetected cancer spread within their bodies inadvertently through a technique that has fallen out of favor called “power morcellation,” which was typically used in these types of surgeries. The technique involves cutting the woman’s uterus or fibroids into small pieces to make them easier to remove during the less invasive laparoscopic procedure.

The new findings (which looked at the cases of more than 19,000 women) support a 2014 estimate by the U.S. Food and Drug Administration that approximately 1 in 350 women undergoing this type of surgery face the risk of hidden cancer. But earlier conventional wisdom was that the risk of undetected cancer for women undergoing this kind of surgery was closer to 1 in nearly 5,000 or more.

(wikimedia commons)

“The take-home message of the study is that the true risk of an undetected cancer at the time of gynecologic surgery for what was assumed to be benign disease is about 1 in 352 women,” says Dr. Rebecca Perkins, a practicing gynecologist at BMC and lead author of the new study.

This kind of minimally invasive surgery had “increased greatly” over the past decade, researchers report, because the procedures involved less pain and shorter recoveries, among other benefits.

But power morcellation came under public and regulatory scrutiny a few years ago (in large part due to excellent reporting by Jennifer Levitz at The Wall Street Journal). In 2014, the FDA issued a series of warnings against the use of laparoscopic power morcellators in the majority of women undergoing these types of gynecologic surgeries because of the risk of spreading unsuspected cancer.

At that time, regulators estimated the risk of hidden cancer this way:

Based on an FDA analysis of currently available data, we estimate that approximately 1 in 350 women undergoing hysterectomy or myomectomy for the treatment of fibroids is found to have an unsuspected uterine sarcoma, a type of uterine cancer that includes leiomyosarcoma. At this time, there is no reliable method for predicting or testing whether a woman with fibroids may have a uterine sarcoma.

If laparoscopic power morcellation is performed in women with unsuspected uterine sarcoma, there is a risk that the procedure will spread the cancerous tissue within the abdomen and pelvis, significantly worsening the patient’s long-term survival. While the specific estimate of this risk may not be known with certainty, the FDA believes that the risk is higher than previously understood.

Since then, the use of laparoscopic power morcellation has fallen, according to Perkins and others in the field. “[Drug maker] Johnson & Johnson recalled the most popular power morcellator,” Perkins said, “and many hospitals banned the procedure and many insurers stopped paying for the use of morcellation with any gynecologic surgery.”

The new study, published online in the journal Women’s Health Issues, confirms the FDA number and also found that the risk of having an undetected cancer rose dramatically with age, with the highest risk among women over 55.

“This is important because it really supports the practice changes that were made around power morcellation and it should be taken as an opportunity to continue to look for safer alternatives for minimally invasive gynecological surgeries for women,” Perkins said.

She added that there are still other morcellators available and “many hospitals and clinics are developing ways to perform safer minimally invasive procedures, such as putting the tissue into a bag prior to removing it in small pieces to avoid the spill of tissue into the abdomen. But the research is still limited and we don’t have a proven, safe alternative that can be presented as the best option for women at this time.”

In clarifying the parameters of these findings, Perkins said: “Our study is not saying morcellation did or didn’t happen” in the cases analyzed, though she said typically it would have been used in the vast majority of such procedures. What it is saying is “if these women got morcellation, how many would have had a cancer morcellated? The answer is 1 in 350.”

So what’s the takeaway for patients?

“I would say women right now may be more likely to have an open abdominal surgery with a larger incision than they would have a few years ago,” Perkins said. “[That] will cause more difficult recoveries for a lot of women but may be lifesaving for a small percentage of women who might have an undetected cancer that could be morcellated, which could worsen their prognosis.”

Here’s more detail from the BMC news release:

Using a national insurance database of 55 million women, Boston Medical Center (BMC) researchers looked at cases from 19,500 women who underwent laparoscopic hysterectomies or myomectomies – procedures which typically incorporate power morcellation – to determine how frequently women are diagnosed with cancer after undergoing a gynecologic surgery for a problem that is believed to be benign. The study revealed that 1 in 352 women had an unsuspected cancer at the time of gynecologic surgery for disease that was thought to be benign. The study is published online in advance of print in the journal Women’s Health Issues.

“Our findings show that the risk for morcellating cancer is much higher than previously understood,” said Michael Paasche-Orlow, MD, MPH, general internal medicine physician at BMC and associate professor of medicine at Boston University School of Medicine (BUSM) who is the study’s senior author. “It makes sense to avoid morcellation for women with cancerous or pre-cancerous lesions. As it is difficult to ascertain in advance, safer alternatives are needed.”

The study also determined that more than half of the patients who were diagnosed with uterine cancer or endometrial hyperplasia, a pre-cancerous condition of the lining of the uterus, did not undergo endometrial testing prior to surgery. Thus, researchers suggest improving how physicians evaluate patients undergoing hysterectomies or myomectomies before they reach the operating room.

Categories: Health Care

#1 State Tax Ranking Is Highly Misleading

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 8:00pm
Wyoming gets the number one ranking in the Tax Foundation’s “2016 State Business Tax Climate Index” — the group’s misleading gauge of state tax systems — largely because of what the state doesn’t have: an income tax on either people or businesses.  In the Tax Foundation’s view, that’s a good thing. But as analysts have pointed out time and time again, the claim that low state taxes are key...
Categories: Benefits, Poverty

FALQs: Danish and Swedish Response to the Current Refugee Crisis—Part II

In Custodia Legis - Thu, 11/19/2015 - 3:00pm

The following is a guest post by Elin Hofverberg. Elin is a foreign law research consultant who covers Scandinavian countries at the Law Library of Congress. Elin has previously written for In Custodia Legis on diverse topics including What’s in an Icelandic (Legal) Name?Glad Syttonde Mai! Celebration of the Bicentenary of the Norwegian ConstitutionHappy National Sami Day!, the bicentenary of Norway’s constitution, and a boarding school scandal in Sweden.

This blog post follows yesterday’s post which focused on Danish and Swedish regulations that apply to eligibility for asylum; the types of residence permits that are available for refugees; and the regulations that apply to family unification as a ground for approval. This post explores the types of benefits to which refugees are entitled in accordance with existing law in Denmark and Sweden. It also provides a list of sources on the history of asylum in the Nordic countries.

1. Are immigrants entitled to financial assistance? 


Denmark has recently cut its financial assistance to immigrants, a move that was advertised in local papers in Lebanon. The move in itself has received considerable criticism but also been deemed as effective.

The current level of cash allowance for a family with two adults and two children living in government assigned housing is DKK 2,711.24 every two weeks (approximately USD 388 per month).


Sweden also provides cash allowances to asylum seekers at approximately USD 751 per month for a family of two adults and two children ages four to 10, if living in government assigned housing.

2. Are immigrants entitled to health and dental care?

Both Denmark and Sweden provide free health care to refugees.


In Denmark individuals awaiting a decision on their asylum application have the right to urgent health care and pain relieving health care.

Children who have sought asylum in Denmark have the same right to care as resident Danish children. This right is not extended to paperless children, i.e. children whose application for asylum has been refused.


Sweden has a special act that regulates health care for asylum seekers who have applied or have been granted asylum. (Lag om hälso- och sjukvård åt asylsökande m.fl. (Act on Health Care for Asylum Seekers et al) (Svensk Författningssamling (SFS) 2008:344).)

Both children seeking asylum and children without proper documentation have the right to health care and dental care at the same level as resident Swedish children. (Id. § 5 and Lag om hälso- och sjukvård till vissa utlänningar som vistas i Sverige utan nödvändiga tillstånd (SFS 2013:407) § 5 (Act on Health Care for Certain Aliens Who are Present in Sweden Without Necessary Papers).)

Asylum seekers and paperless immigrants 18 years of age and older have the right to urgent care, maternity care, abortions and family planning care. (Act on Health Care for Asylum Seekers et al § 6; Act on Health Care for Certain Aliens Who are Present in Sweden Without Necessary Papers § 7.) Local County Councils have the right to provide additional care for paperless immigrants. (Act on Health Care for Certain Aliens Who are Present in Sweden Without Necessary Papers § 8.) They also have the right to a general health assessment unless the local County Council finds that it is not necessary. (Id. § 10.)

3. What are the policies regarding schooling for immigrant children? 

Children of asylum seekers have the right to attend school both in Denmark and in Sweden.

In Denmark schooling may be conducted either at the asylum center or at a regular school.

In Sweden children who have sought asylum have the right to attend the local school between ages six and 18 or until they finish high school. The state compensates the municipality for the additional costs.

4. Are there any special rules for unaccompanied minors?

Both Denmark and Sweden have special rules for unaccompanied minors who seek refuge in their respective countries.

Danish law requires speedier review of the asylum case and special housing. Temporary residence permits are issued for four years at a time until the minor turns 18 after which he or she can apply for a permanent residence permit under the same rules as other adult asylum seekers.

Sweden also has special rules for unaccompanied children, including permanent residence permits, the appointment of a custodian, special housing, the right to go to school, etc.

Under Swedish law deportation of a minor requires that the Migrant Office has made sure that a family member, appointed custodian or a suitable arrival facility will take care of the child when arriving in his or her home country. (Swedish Aliens Act, ch. 12 § 3a.)

Sweden reportedly now has the greatest number of unaccompanied minors seeking asylum within its borders. Between January and September of this year 14, 000 unaccompanied children have reportedly reached Sweden. During the week of October 11 to October 18 of this year, 2,441 unaccompanied children applied for asylum in Sweden, mostly from Afghanistan.

5. Domestic policies and EU responsibilities

Although Sweden and Denmark are both part of the EU and bound by its decisions, Denmark has opted out of home affairs and therefore has the right to regulate how many asylum seekers it takes in and need not agree to any relocation efforts. Denmark, thus, is not bound by the EU Council Decision to relocate some 120,000 refugees agreed to in September. (Council Decision (EU) 2015/… of … Establishing Provisional Measures in the area of International Protection for the Benefit of Italy and Greece.) The Danish government has, however, announced that it would take in 1,000 asylum seekers under the scheme.

Sweden is bound to take approximately 5,000, 19 of whom have already arrived. In addition, Sweden has agreed to take 1,900 United Nations High Commissioner for Refugees (UNHCR) refugees in 2015 commonly known as quota refugees, while Denmark will accept approximately 500. Denmark has a flexible system, allowing them to receive 1,500 over a three year-period.

In an unexpected move on November 4, 2015, the Swedish Prime Minister Stefan Löfven announced that Sweden had decided to ask the European Commission that instead of receiving asylum seekers under the September agreement, it would be allowed to redistribute asylum seekers from Sweden as the country increasingly struggled with finding housing for the approximately 10,000 asylum seekers it receives per week.

In response to Sweden’s request for redistribution, Denmark’s Minister for Integration Inger Støjberg responded by saying that Sweden had brought this situation onto itself with its generous policies and would therefore have to live with the consequences of them.

In an attempt to address the problem, the Swedish government on November 12 decided to temporarily reintroduce internal border controls, thereby forcing potential asylum seekers to either apply for asylum in Sweden or return to the EU member country from which they have arrived (in effect Denmark or Germany). Individuals traveling to Sweden by boat or train have been informed that they need to present identification to board the vessels. Government officials have expressed hope that the move would reduce the number of individuals seeking asylum in Sweden. The primary reason for the new policy, according to the Prime Minister Löfven, was to prevent Sweden from being a transit country and making the arrival in Sweden more orderly for those seeking asylum.

On November 13 the Danish government proposed new asylum rules which among other things will delay family reunification from one year residence to three years residence.  No final agreement has been reached. So far the government has gained support for 13 of its 34 proposals.

6. Repatriation policy

Both Denmark and Sweden sponsor programs for return of refugees to their home countries.

7. For further information

For the history of asylum in the Nordic countries, I recommend browsing through the Library’s collection which includes:

For Denmark:

For Sweden

Ingela Fridström, Ulrika Sandell, Ingrid Utne, Migrationsprocessen (2007);

If you want to read more about the refugee crisis in Europe, I recommend Theresa’s Global Legal Monitor articles on the redistribution of refugees and on the EU Turkey cooperation. Theresa has also recently blogged about the European Union’s Approach to the Current Refugee Crisis.

Categories: Research & Litigation

Weaker Unions Likely Would Mean Greater Income Inequality

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
The Supreme Court is considering a case that could have implications for income inequality, which has grown across the country and in individual states since the 1970s, as we’ve documented here and here. The case, Friedrichs v. the California Teachers Association, concerns unions that represent state and local employees.  The Supreme Court has long held that while public employees cannot...
Categories: Benefits, Poverty

Funding for Housing, Health, and Social Services Block Grants Has Fallen Markedly Over Time

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
Funding for housing, health, and social services block grants has fallen significantly over time, an examination of several decades of budget data demonstrates.  These data provide a cautionary tale for proposals to merge large numbers of additional programs — especially programs serving families and individuals who are low income or otherwise vulnerable — into block grants, as would occur,...
Categories: Benefits, Poverty

TANF Work Requirements Don’t Bring Stable Jobs, Higher Earnings

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
November 19, 2015: We've updated this post to clarify the figure about sanctions for non-compliance with Maryland's work requirement. House Speaker Paul Ryan has called for another round of welfare reform, “as an exercise to save lives and to get people from welfare to work and realize opportunity and upward mobility.”  But the first round of welfare reform didn’t accomplish what Speaker...
Categories: Benefits, Poverty

Greenstein: Senate Transportation-Housing Bill Raises Serious Concerns

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
The Transportation-Housing and Urban Development (HUD) appropriations bill that the Senate began considering today uses none of the flexibility created by the recent budget agreement to boost rental assistance for poor families, despite rising rents, the growing number of poor families struggling to pay rent, and rising homelessness. The T-HUD bill uses none of the flexibility created by the...
Categories: Benefits, Poverty

The Role of Neighborhoods in Persistent Poverty

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
Update, November 18:  We’ve updated this post to add a second video clip of the forum. CBPP’s recent forum, “Poverty and Place: A Dialogue on the Role of Neighborhoods in Persistent Poverty and the Implications for Policy,” featured a presentation by Harvard economist Raj Chetty of his two groundbreaking studies (first video clip below), a talk with Office of Management and Budget...
Categories: Benefits, Poverty

“Moving to Work” Housing Program Raises Serious Concerns

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
The Moving to Work (MTW) demonstration permits 39 state and local housing agencies to obtain broad waivers of federal rules governing the public housing and Housing Choice Voucher programs so they can test alternative policies related to work and other areas. MTW has fostered some useful innovations but has also had serious adverse effects. Congress should not expand it without significant...
Categories: Benefits, Poverty

EITC Could Be Important Win for Obama and Ryan

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
“[Y]ou can oppose the president on some issue that you fundamentally disagree with, but also work with the other party on issues you do agree with,” new House Speaker Paul Ryan told CBS’ “60 Minutes” last night.  On one critical issue, Speaker Ryan and President Obama not only agree but have a nearly identical proposal: expanding the Earned Income Tax Credit (EITC) for childless adults — the...
Categories: Benefits, Poverty

In Case You Missed It…

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
This week at CBPP, we focused on food assistance, the federal budget and taxes, Social Security, housing, state budgets and taxes, health, and the economy. On food assistance, Richard Kogan and Dottie Rosenbaum described how Congress can protect recipients of SNAP (formerly food stamps) and the child nutrition programs from losing benefits due to failures in the appropriation process. On...
Categories: Benefits, Poverty

The Truth About Corporate Income Taxes

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
My latest post for the US News & World Report Economic Intelligence blog provides a reality check on corporate income taxes.  Here are some excerpts: Are you hearing that U.S. corporations are taxed much more than their international competitors, making it harder for them to compete in global markets? Those who think so want policymakers to substantially cut...
Categories: Benefits, Poverty

Better Access to Nutrition Improves Health

Center on Budget and Policy Priorities - Thu, 11/19/2015 - 3:00pm
Children in households lacking adequate access to food are at least twice as likely to be in fair or poor health as other children, a new review of research on the link between “food insecurity” and health finds.  Food insecurity among children is also linked to greater risk of asthma, anemia, cognitive and behavioral problems, depression, and worse overall health.  The patterns are...
Categories: Benefits, Poverty


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